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1.
BMC Surg ; 21(1): 122, 2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33685435

RESUMO

BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) is primary cancer of the liver with poor prognosis because of its high potential for recurrence and metastasis. We experienced a rare case of ICC with hematogenous metastasis to the falciform ligament. We aimed to clarify the route of metastasis to the mesentery by increasing the accuracy of preoperative imaging and establish a hepatectomy to control cancer. CASE PRESENTATION: An 85-year-old woman was referred to our hospital for a detailed study of progressively increasing liver tumors. She had no subjective symptoms. Her medical history showed hypertension, aneurysm clipping for cerebral hemorrhage, and gallstones. A detailed physical examination and laboratory data evaluation included tumor markers but did not demonstrate any abnormalities. On computed tomography scan, contrast-enhanced ultrasound, and magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid, the tumor appeared to be located in liver segment IV, protruding outside the liver. It appeared to contain two distinct components; we suspected ICC in the intrahepatic tumor component. Laparoscopic observation revealed that the extrahepatic lesion was an intra-falciform ligament mass; laparoscopic left hepatectomy was performed. Microscopically, the main tumor in segment IV was 15 mm in diameter and was diagnosed as moderately and poorly differentiated ICC. The tumor of the intra-falciform ligament was not continuous with the main intrahepatic nodule and was also diagnosed as ICC with extensive necrosis. There were no infiltrates in the round ligament of the liver, and several tumor thrombi were found in the small veins of the falciform ligament. CONCLUSIONS: To date, there have been a few reports of metastases of primary liver cancer to the falciform ligament. At the time of preoperative imaging and pathological diagnosis, this case was suggestive of considering that the malignant liver tumor might be suspected of metastasizing to the falciform ligament. Our case improves awareness of this pathology, which can be useful in the future when encountered by hepatic specialists and surgeons.


Assuntos
Colangiocarcinoma , Ligamentos , Neoplasias Hepáticas , Idoso de 80 Anos ou mais , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/patologia , Colangiocarcinoma/cirurgia , Feminino , Hepatectomia/métodos , Humanos , Laparoscopia , Ligamentos/diagnóstico por imagem , Ligamentos/patologia , Ligamentos/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia
2.
Arthroscopy ; 37(1): 231-233, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384084

RESUMO

The anatomy, function, and existence of the anterolateral ligament (ALL) is still hotly debated and a controversial topic. Currently both basic biomechanical and clinical studies are not providing sufficient and strong evidence to either support or refute that the ALL plays an important role for knee stability. One could argue that stability is provided by the anterolateral complex, including the iliotibial band, Kaplan fibers, and the anterolateral capsule, which may contain a structure called the ALL. Magnetic resonance imaging (MRI) is routinely performed in patients with anterior cruciate ligament (ACL) injury, but unfortunately ALL injuries cannot be reliably diagnosed in patients with concomitant ACL tears. When dividing ALL injuries into high and low grade using preoperative MRI and investigating clinical outcomes after double-bundle ACL reconstruction, patients with high-grade injuries have inferior outcomes and a significantly greater revision rates. However, the limitations of this research reduce the validity of these conclusions: high rate of loss to follow-up above accepted standard, unequal size of their study groups, fragility index of zero, the inaccuracy of diagnosing ALL injuries in the presence of ACL tears on MRI, and the dilemma with randomly classifying high- and low-grade ALL injury based on MRI.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Joelho , Articulação do Joelho/cirurgia , Ligamentos/cirurgia
3.
BMC Surg ; 21(1): 4, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397346

RESUMO

BACKGROUND: Mesentericoportal vein (MPV) resection in pancreatic ductal adenocarcinoma (PDAC) surgery has become a common procedure. A few studies had described the use of falciform ligament (FL) for MPV reconstruction and received encouraging preliminary effects. AIMS: This study was designed to explore the feasibility and efficacy of this technique compared with others. METHODS: Patients who underwent pancreaticoduodenectomy (PD) with MPV resection for PDAC from 2009 to 2018 were enrolled. Medical records were retrospectively reviewed, MPV reconstructions using FL were distinguished and compared with other techniques. RESULTS: 146 patients underwent MPV reconstruction, and 13 received FL venoplasty. Other reconstruction techniques included primary end-to-end anastomosis (primary, n = 30), lateral venorrhaphy (LV, n = 19), polytetrafluoroethylene conduit interposition (PTFE, n = 24), iliac artery (IA) allografts interposition (n = 47), and portal vein (PV) allografts interposition (n = 13). FL group holds the advantages of shortest operation time (p = 0.023), lowest blood loss (p = 0.109), and shortest postoperative hospital stay (p = 0.125). The grouped patency rates of FL, primary, LV, PTFE, IA, and PV were 100%, 90%, 68%, 54%, 68%, and 85% respectively. Comparison displayed that FL had the highest patency rate (p = 0.008) and lowest antiplatelet/anticoagulation proportion (p = 0.000). Complications and long-term survival were similar among different techniques. The median survival time of patent group (24.0 months, 95% CI: 22.0-26.0) was much longer than that of the thrombosed (17.0 months, 95% CI: 13.7-20.3), though without significant difference (P = 0.148). CONCLUSIONS: PD with MPV resection and reconstruction by FL is safe, feasible, and efficacious, it might provide a potential benefit for patients.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Ligamentos/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Veia Porta/cirurgia , Anastomose Cirúrgica , Estudos de Coortes , Estudos de Viabilidade , Humanos , Masculino , Veias Mesentéricas/cirurgia , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
4.
Zhonghua Fu Chan Ke Za Zhi ; 56(1): 27-33, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33486925

RESUMO

Objective: To study the anatomical relationship among uterosacral ligament and ureter or rectum by using MRI three-dimensional reconstruction model in pelvic organ prolapse (POP) patients. Methods: According to the research standard, 67 POP patients were enrolled, who accepted pelvic MRI before surgery in Nanfang Hospital, Southern Medical University during May 2015 to March 2020. Three-dimensional model of uterosacral ligament was reconstructed. The intersection point of the fitting curve of uterosacral ligament and ischial spine level marked point P0, every 1 cm increasing from P0 towards the sacrum marked points P1, P2, and P3. Distances were measured between rectum or ureter to uterosacral ligament respectively at the P0-P3 horizontal levels. Results: (1) The distances between the left ureter and the left uterosacral ligament were (15.45±7.46) to (19.31±11.38) mm, and the distances between the right ureter and the right uterosacral ligament were (13.77±8.16) to (14.78±9.18) mm. At the P1 horizontal level ureters were the closest to uterosacral ligaments, and the right ureter was the closest to right uterosacral ligament [(13.45±9.34) mm] at P2 horizontal level in severe POP group. The farthest distance presented at the P3 horizontal level between bilateral ureters and uterosacral ligaments. (2) At the P0 horizontal level, the rectum was the closest to the bilateral uterosacral ligaments [left: (20.62±9.99) mm, right: (16.82±9.63) mm; P=0.026], and the rectum was closer to the right uterosacral ligament. There were no significant differences in the distance between rectum and bilateral uterosacral ligaments in mild POP group (P>0.05), and the results of severe POP group also showed the rectum was closer to the right uterosacral ligament [(15.64±10.31) mm at P0 horizontal level]. Conclusions: Right ureter and rectum are closer to the right uterosacral ligament. Gynecologists should pay more attention to avoid damaging the right ureter and rectum during the operation of the right uterosacral ligament in POP patients.


Assuntos
Ligamentos/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Prolapso de Órgão Pélvico/patologia , Reto/anatomia & histologia , Reto/diagnóstico por imagem , Sacro/anatomia & histologia , Sacro/diagnóstico por imagem , Ureter/anatomia & histologia , Ureter/diagnóstico por imagem , Adulto , Feminino , Humanos , Ligamentos/anatomia & histologia , Ligamentos/patologia , Ligamentos/cirurgia , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/diagnóstico por imagem , Prolapso de Órgão Pélvico/cirurgia , Reto/cirurgia , Sacro/cirurgia , Ureter/cirurgia
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1144-1148, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353267

RESUMO

Colorectal surgeons have focused on the lateral structure of rectum for a long time and lateral ligament is the common term to depict this structure. A better understanding of lateral rectal structure could be beneficial to performing the total mesorectum excision (TME) procedure and protecting patients' urinary, sexual and defecation function. The main controversies focus on two aspects: (1) Does the lateral ligament exist? (2) What dose it contain? Does the middle rectal artery exist? Up to now, anatomic studies have failed to reach consensus on the lateral rectal structure. However, surgeons do find the lateral rectal ligament during surgery and it may be the pathway for lateral lymph node metastasis in rectal cancer. The lateral rectal structure contains the middle rectal artery, nerve branches, lymphatics and adipose fibrous tissue around them. We summarize our clinical experience and conclude that the middle rectal artery appears in lateral ligament constantly but some of them are too small to be easily observed. Therefore, regarding the perspective of membrane anatomy, embryology and surgery, this structure may be more appropriate to be called the "lateral mesorectum". We propose this new term based on the previous literature and our own experience for the readers' reference.


Assuntos
Ligamentos/anatomia & histologia , Artéria Mesentérica Inferior/anatomia & histologia , Mesentério/anatomia & histologia , Neoplasias Retais , Reto/anatomia & histologia , Humanos , Ligamentos/irrigação sanguínea , Ligamentos/cirurgia , Linfonodos/anatomia & histologia , Linfonodos/cirurgia , Artéria Mesentérica Inferior/cirurgia , Mesentério/irrigação sanguínea , Mesentério/cirurgia , Pelve/anatomia & histologia , Pelve/cirurgia , Neoplasias Retais/cirurgia , Reto/irrigação sanguínea , Reto/cirurgia
6.
Orthopade ; 49(11): 976-984, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33025037

RESUMO

BACKGROUND: Adult acquired flatfoot deformity is characterized by a progressive functional deficit of the foot that leads to an eversion of the subtalar joint complex with heel valgus, abduction of the forefoot and collapse of the medial arch. In the case of a flexible deformity, a joint-preserving operative reconstruction is advisable, which should correct all elements of the deformity. A calcaneal lengthening osteotomy can correct excessive abduction of the forefoot, which can be measured by the amount of talar head uncoverage visible on AP weight-bearing x­rays of the foot. THERAPY: Any calcaneal lengthening osteotomy leads to an incongruence between talar and calcaneal joint surfaces of the subtalar joint, which is a risk factor for secondary degenerative changes. It is, therefore, advisable to limit the amount of lengthening to the necessary minimum. A residual heel valgus can be corrected by an additional medial displacement osteotomy as adjunct to the calcaneal lengthening. Calcaneal osteotomies are usually part of a complex reconstruction of advanced but still flexible adult flatfoot deformities. In addition to the correction of the hindfoot deformity, persistent forefoot supination needs to be corrected. In cases of midfoot instability, which is frequently located in the naviculo-cuneiforme joint line, a corrective arthrodesis is recommended. Without midfoot instability forefoot a Cotton osteotomy is able to reduce forefoot supination and add to reconstruction of the medial arch of the foot. All bony corrections should be combined with soft tissue reconstruction, i.e. spring ligament repair, Flexor tendon transfer and, in cases of gastrocnemius shortening, a gastroc recession.


Assuntos
Calcâneo/cirurgia , Pé Chato/cirurgia , Deformidades Adquiridas do Pé , Ligamentos/cirurgia , Osteotomia/métodos , Adulto , Alongamento Ósseo/métodos , Calcâneo/diagnóstico por imagem , Pé Chato/diagnóstico por imagem , , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/cirurgia , Humanos , Complicações Pós-Operatórias , Transferência Tendinosa , Tendões/fisiopatologia , Tendões/cirurgia , Resultado do Tratamento
7.
Orthopade ; 49(8): 660-668, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32737513

RESUMO

BACKGROUND: Septic arthritis is an acute emergency. It occurs more frequently in patients with pre-existing degenerative or chronic inflammatory joint diseases than in the general population. The causative microorganisms can be introduced in various ways. DIAGNOSTICS: A rapid diagnosis is of great importance for the success of the therapy. In the clinical examination, the typical signs of inflammation are noticeable. The gold standard is the aspiration of synovial fluid and the subsequent laboratory and microbiological investigation. THERAPY: A prerequisite for successful therapy is the early initiation of an antimicrobial pathogen-specific treatment and the surgical alleviation of the joint.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Drenagem/métodos , Ligamentos/cirurgia , Complicações Pós-Operatórias/microbiologia , Líquido Sinovial/microbiologia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Infecções Bacterianas/microbiologia , Doença Crônica , Terapia Combinada/métodos , Gerenciamento Clínico , Humanos , Inflamação/etiologia , Inflamação/microbiologia , Líquido Sinovial/metabolismo
8.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(4): 453-456, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-32691549

RESUMO

Objective: To explore the feasibility and safety of teres hepatis ligament flap plasty around the gastroduodenal artery (GDA) stump to prevent postoperative hemorrhage after laparoscopic pancreatoduodenectomy (LPD). Methods: A total of 108 patients with GDA stump wrapped by pedicled teres hepatis ligament after LPD in our center were included for analysis from March 2018 to March 2019. After completion of LPD, teres hepatis ligament was dissected from the ventral abdominal cephalad along the ventral attachment, and the teres hepatis ligament was separated from the falciform ligament by ultrasonic scalpel or Ligasure. At the junction to the liver, the teres hepatis ligament is freed from the ventral hepatic surface. The junction between liver and teres hepatis ligament should not be cut off to ensure blood supply. Division of the GDA was performed using a Prolene 4-0 suture stitch or two clamps as a standard (see the Video 1 in Supplemental Contents, http://ykxb.scu.edu.cn/article/doi/10.12182/20200760602). The pedicled teres hepatis ligament then was used to completely cover the skeletonized GDA stump, and part of the common hepatic artery and the proper hepatic artery. The mobilized ligament can be transposed without tension. Results: A total of 108 patients completed the procedure of GDA stump wrapped with pedicled teres hepatis ligament during LPD. There were no complications caused by GDA stump after operation. The main steps to wrap the GDA stump took an average of 10 min. Clinically relevant postoperative pancreatic fistula (CR-POPF) occurred in 8 cases (7.4%) (including 6 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula), and intra-abdominal infection in 8 cases (7.4%), including 3 cases (2.8%) of intra-abdominal abscess, postoperative gastrointestinal ulcer bleeding occurred in 2 cases (1.9%), and no intra-abdominal hemorrhage occurred. Conclusion: It is a safe and feasible procedure of wrapping GDA stump with pedicled teres hepatis ligament to prevent postoperative hemorrhage after LPD. The procedure is easy to perform without relevant additional surgical trauma or prolongation of the operation time.


Assuntos
Artéria Hepática , Laparoscopia , Ligamentos , Pancreaticoduodenectomia , Hemorragia Pós-Operatória , Artéria Hepática/cirurgia , Humanos , Ligamentos/cirurgia , Pancreaticoduodenectomia/métodos , Hemorragia Pós-Operatória/prevenção & controle
9.
Medicine (Baltimore) ; 99(29): e20940, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702833

RESUMO

RATIONALE: Schwannomas are mesenchymal tumors with low malignant potential that originate from Schwann cells. They can occur in most parts of the body, such as the head, neck, and extremities. Schwannoma in the hepatoduodenal ligament is extremely rare, and only four cases have been reported in the literature. PATIENT CONCERNS: Herein, we describe a 58-year-old female who presented with right epigastric pain for 10 days. Preoperative computed tomographic (CT) revealed a 4.5 cm × 3.8 cm tumor in the hepatic hilar area. DIAGNOSES: Schwannoma in the hepatoduodenal ligament with portal vein invasion. INTERVENTIONS: Intraoperative findings revealed that the tumor was identified in the hepatoduodenal ligament, and the left branch of the portal vein was compressed. Complete tumor resection with reparation of the portal vein was performed for the patient. Postoperative pathological examination confirmed the final diagnosis of benign schwannoma, characterized by abundant spindle-shaped cells and positive reactivity for S-100 protein. OUTCOMES: The patient had a good prognosis and had no recurrence after 37 months of follow-up. LESSONS: Our case of schwannoma in the hepatoduodenal ligament is unique owing to the portal vein invasion, aimed at helping recognize the difficulty of preoperative diagnosis.


Assuntos
Ligamentos/patologia , Neurilemoma/patologia , Omento/patologia , Neoplasias Peritoneais/patologia , Veia Porta/patologia , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Ligamentos/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Omento/diagnóstico por imagem , Omento/cirurgia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgia , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Tomografia Computadorizada por Raios X
10.
Facial Plast Surg ; 36(3): 309-316, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32557438

RESUMO

Preservation of the facial nerve is crucial in any type of facial procedure. This is even more important when performing plastic surgery on the face. An intricate knowledge of the course of the facial nerve is a requisite prior to performing facelifts, regardless of the technique used. The complex relationship of the ligaments and the facial nerve may put the nerve at an increased risk of damage, especially if its anatomy is not fully understood. There are several danger zones during dissection where the nerve is more likely to be injured. These include the areas where the nerve branches become more superficial in the dissection plane, and where they traverse between the retaining ligaments of the face. Addressing these ligaments is crucial, as they prevent the transmission of traction during facelifts. Without sufficient release, a satisfying pull on the soft tissues may be limited. Traditional superficial musculoaponeurotic system techniques such as plication or imbrication do not include surgical release of these attachments. Extended facelift techniques include additional dissection to release the retaining ligaments to obtain a more balanced and healthier look. However, these techniques are often the subject of much debate due to the extended dissection that carries a higher risk of nerve complications. In this article we aim to present the relationship of both the nerve and ligaments with an emphasis on the exact location of these structures, both in regard to one another and to their locations within the facial soft tissues, to perform extended techniques safely.


Assuntos
Ritidoplastia , Sistema Musculoaponeurótico Superficial/cirurgia , Face/cirurgia , Nervo Facial , Ligamentos/cirurgia
11.
J Surg Res ; 254: 91-95, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32422431

RESUMO

BACKGROUND: Operative approaches for superior mesenteric artery syndrome (SMAS) vary from Roux-en-Y duodenojejunostomy to the more conservative division of the ligament of Treitz with inferior duodenal derotation known as the Strong procedure. We sought to examine outcomes following a modified version of Strong procedure where the duodenum is lowered as opposed to derotated for the management of SMAS. MATERIALS AND METHODS: We conducted a retrospective chart review of children who underwent surgical management of SMAS between January 2008 and December 2017. An online survey regarding symptom resolution, feeding practices, and the need for additional procedures was distributed. Data are reported as medians with interquartile range (IQR) and proportions as percentages. RESULTS: Seven patients with a median age of 15 y (IQR 8, 16) and median body mass index of 16.9 (IQR, 12.6, 22.1) were included. Presenting symptoms included pain (71%), nausea (57%), and vomiting (43%). Six patients initially underwent duodenal lowering, whereas one patient underwent duodenoduodenostomy. One patient underwent adhesiolysis for bowel obstruction in the early postoperative period. All patients had symptom resolution at a postoperative follow-up of 22 d (IQR, 15, 45). Two patients had symptom recurrence, and one patient required reoperation. Six patients completed the survey at a median of 2.3 y (IQR, 1.7, 3.2) postoperatively, of which four underwent duodenal lowering. Of these, 75% (n = 3) were asymptomatic. One patient with recurrence reported occasional nausea and emesis but has not required additional surgery. CONCLUSIONS: Release of the ligament of Treitz with duodenal lowering results in resolution of symptoms in 75% of patients. This operative approach may be considered before performing more complex operations for SMAS.


Assuntos
Duodeno/cirurgia , Ligamentos/cirurgia , Síndrome da Artéria Mesentérica Superior/cirurgia , Adolescente , Criança , Humanos , Náusea , Dor , Recidiva , Estudos Retrospectivos , Rotação , Síndrome da Artéria Mesentérica Superior/diagnóstico , Inquéritos e Questionários , Resultado do Tratamento , Vômito
12.
Arch Orthop Trauma Surg ; 140(7): 923-931, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32140829

RESUMO

BACKGROUND: Anterolateral augmentation procedures can be divided into traditional lateral extra-articular tenodesis (LET) and modern anterolateral ligament (ALL) reconstruction. Nevertheless, no studies have compared the clinical results between LET and ALL reconstruction, when combined with intra-articular ACL reconstruction. This study was therefore designed to compare the clinical results, including the anterior translation, rotational laxity, and patient-reported outcomes, in a group of patients who underwent ACL reconstruction combined with LET or ALL reconstruction. METHODS: All studies systematically searched until March 2018 without any language restriction that reported the results of a lateral extra-articular stabilization procedure using either LET or ALL reconstruction methods combined with ACL reconstruction were evaluated. Two reviewers independently recorded data from each study, including the sample size, improvement in Lysholm score, and the number of patients with each grade of knee laxity using Lachman and pivot shift tests. RESULTS: The pooled results of ten studies showed that the postoperative proportion of knees with grade 2 or 3 on the Lachman test was significantly higher following LET compared with ALL reconstruction in combination with ACL reconstruction (10.8%, 95% confidence interval [CI]: 6.6-17.1% vs. 1.5%, 95% CI 0.5-4.5%; p = 0.001). However, the pooled results of 12 studies showed that the proportion of knees that belonged to grade 2 or 3 on the pivot shift test, indicating poor rotational stability, was similar between these two techniques (4.9%, 95% CI 2.0-11.5% vs. 2.3%, 95% CI 1.1-4.5%; p = 0.101). The pooled improvements in Lysholm scores in these two groups were also similar (32.3, 95% CI 26.8-37.9 vs. 25.7, 95% CI 16.7-34.7, p = 0.218). CONCLUSION: LET could lead to worse anterior instability than with ALL reconstruction when these two approaches were combined with single-bundle ACL reconstruction. However, rotational stability and patient-reported outcomes were similar between the techniques.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Ligamentos/cirurgia , Tenodese , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Humanos , Tenodese/efeitos adversos , Tenodese/métodos , Tenodese/estatística & dados numéricos , Resultado do Tratamento
13.
Int J Gynaecol Obstet ; 149(3): 292-297, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32196660

RESUMO

OBJECTIVE: To compare safety, efficacy, and impact on quality of life (QoL) between ischial spine fascia fixation (ISFF) and sacrospinous ligament fixation (SSLF) for stage 2-3 pelvic organ prolapse (POP). METHOD: A prospective cohort study among women with POP attending a national referral university hospital in Beijing, China, between May 2007 and May 2015. Women underwent either ISFF or SSLF. Primary end point was objective success rates at 3 months after surgery. Exploratory outcomes included perioperative parameters, complications, subjective satisfaction rates and QoL at 1 year. RESULTS: There was no difference in baseline characteristics between the groups (all P>0.05). After ISFF and SSLF, the objective success rate at 3 months was 100% and 98.1% (P>0.99), the recurrence rate at 1 year was 5.3% and 8.3% (P=0.266), and the subjective satisfaction rate at 1 year was 97.8% and 97.9%, respectively. Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores improved significantly after ISFF. De novo urinary incontinence occurred for 5.3% and 6.3% of women, respectively, and de novo dyspareunia for approximately 14% of women in both groups. CONCLUSION: ISFF was found to be a safe and effective alternative to SSLF for women with symptomatic stage 2 and 3 POP.


Assuntos
Fáscia , Ísquio/cirurgia , Ligamentos/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Adulto , Idoso , China , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários
14.
J Pediatr Orthop ; 40(4): e306-e311, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32032220

RESUMO

BACKGROUND: Madelung deformity arises from a partial distal radial growth disturbance in combination with an abnormal hypertrophic ligament spanning the volar radius and carpus, termed, the Vickers ligament. The purpose of this study is to report long-term clinical and radiographic outcomes following Vickers ligament release and distal radial physiolysis in a population of skeletally immature patients with symptomatic Madelung deformity. METHODS: Medical records were retrospectively reviewed of patients with Madelung deformity surgically treated between 1994 and 2005. All eligible patients who underwent a Vickers ligament release and distal radial physiolysis were contacted and invited to return to the clinic for follow-up. RESULTS: Six patients (8 wrists) with Madelung deformity underwent Vickers ligament release and distal radial physiolysis. All were white females with a mean age at initial presentation of 11.4 years (10 to 12.8 y). Mean age at the time of initial surgery was 12.0 years (10.0 to 14.5 y). The median follow-up time was 10.6 years (5.8 to 21.9 y) and the average age at last follow-up was 23.1 years (17.5 to 32.2 y). Pain alone or in combination with concerns for deformity was the chief complaint in 6 of 8 of the wrists. At 1 year of clinical follow-up, 7 of 8 wrists were reported to be pain-free, and 6 of the 8 were noted to be completely pain-free at last follow-up. Motion in flexion, extension, pronation, supination, radial, or ulnar deviation was similar between the preoperative status and long-term follow-up. The average preoperative ulnar tilt was 35.1 degrees (SD: 8.5 degrees), average preoperative lunate subsidence was 1.9 degrees (SD: 1.8 degrees), and average preoperative palmar carpal displacement was 21.9 degrees (SD: 2.9 degrees). At the final follow-up, there was a large progression in lunate subsidence, but minimal change in ulnar tilt and palmar carpal displacement. At last clinical follow-up, 2 of the 6 patients had undergone a subsequent procedure including 1 radial dome osteotomy and 1 ulnar shortening osteotomy. CONCLUSION: In the skeletally immature patient population with Madelung deformity with growth potential remaining, distal radial physiolysis and Vickers ligament release is associated with relief of pain, preservation of motion, and, a reasonable rate of reoperation. TYPE OF STUDY: This was a therapeutic study. LEVEL OF EVIDENCE: Level II.


Assuntos
Transtornos do Crescimento/cirurgia , Ligamentos , Osteocondrodisplasias/cirurgia , Osteotomia , Rádio (Anatomia) , Articulação do Punho , Criança , Feminino , Humanos , Ligamentos/anormalidades , Ligamentos/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Amplitude de Movimento Articular , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tempo , Articulação do Punho/fisiopatologia , Articulação do Punho/cirurgia
15.
BMC Surg ; 20(1): 20, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000756

RESUMO

BACKGROUND: Pancreatic pseudocyst is a very common benign cystic lesion of the pancreas. It develops in 5-15% of patients with peri-pancreatic fluid collection following acute pancreatitis. Collection usually occurs within the lesser sac of the omentum (near the pancreatic head and body region). But in 20-22% cases, that may be extra-pancreatic like in the mediastinum, pleura, in the peritoneal cavity including the pelvis. The pancreatic pseudocyst typically contains brownish fluid with necrotic tissue sludge which may get infected giving rise to infected pseudocyst or pancreatic abscess. The present case is an unusual condition of a young alcoholic subject who was finally diagnosed as a case of a pancreatic abscess within hepato-gastric ligament and was managed with operative intervention. To the best of the author's knowledge, it is the first-ever reported case of a pancreatic abscess within the hepato-gastric ligament in the world. Literature was reviewed to explore potential etiopathogenesis and therapeutic strategies of this extremely rare condition. CASE PRESENTATION: A 38 years old gentleman, chronic alcoholic, having a previous history of acute pancreatitis 3 months back, presented with fever (102 degrees Fahrenheit) and a huge [20 cm (horizontal) X 15 cm (vertical)] severely painful swelling in the epigastric region. The swelling was round-shaped, intra-abdominal, fixed to deeper tissue, tense-cystic, poorly trans-illuminant, non-pulsatile and irreducible. Routine blood tests showed leucocytosis (14,500/mm3) with neutrophilia and elevated plasma pancreatic amylase and lipase levels. USG and MDCT scan of the whole abdomen revealed a thick-walled echogenic cystic swelling of size 18 cm × 12 cm in the epigastric region. USG guided aspiration of the cyst revealed mixed purulent brownish fluid. The cyst fluid was negative for mucin stain and contained high amylase level with low CEA level, suggesting infected pancreatic pseudocyst. An open drainage procedure was considered through an upper midline laparotomy. Aspiration of the pus mixed cyst fluid along with tissue debris was done. Through irrigation of the cyst was done with normal saline. The cyst wall was de-roofed leaving a small part adherent to the inferior surface of the left lobe of the liver. Later the cyst fluid culture showed significant growth of Escherichia coli. He was put on IV antibiotics. The patient was discharged in a stable condition after 5 days. The histopathological examination confirmed pancreatic abscess. Six months after the operation, the patient is doing well, remaining asymptomatic and there is no sign of recurrence. CONCLUSIONS: Due to extreme rarity, pancreatic abscess formation within hepato-gastric ligament may be a diagnostic dilemma and requires a high index of suspicion. Surgeons should be aware of this rare clinical entity for prompt management of potential morbidity.


Assuntos
Abscesso/diagnóstico , Pâncreas/patologia , Pseudocisto Pancreático/diagnóstico , Abscesso/cirurgia , Doença Aguda , Adulto , Cistos/diagnóstico , Cistos/cirurgia , Drenagem/métodos , Humanos , Laparotomia/métodos , Ligamentos/patologia , Ligamentos/cirurgia , Fígado/patologia , Masculino , Pâncreas/cirurgia , Estômago/patologia , Estômago/cirurgia , Tomografia Computadorizada por Raios X
16.
J Nanobiotechnology ; 18(1): 23, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000800

RESUMO

Ligaments and tendons are fibrous tissues with poor vascularity and limited regeneration capacity. Currently, a ligament/tendon injury often require a surgical procedure using auto- or allografts that present some limitations. These inadequacies combined with the significant economic and health impact have prompted the development of tissue engineering approaches. Several natural and synthetic biodegradable polymers as well as composites, blends and hybrids based on such materials have been used to produce tendon and ligament scaffolds. Given the complex structure of native tissues, the production of fiber-based scaffolds has been the preferred option for tendon/ligament tissue engineering. Electrospinning and several textile methods such as twisting, braiding and knitting have been used to produce these scaffolds. This review focuses on the developments achieved in the preparation of tendon/ligament scaffolds based on different biodegradable polymers. Several examples are overviewed and their processing methodologies, as well as their biological and mechanical performances, are discussed.


Assuntos
Materiais Biocompatíveis/química , Ligamentos/cirurgia , Nanocompostos/química , Polímeros/química , Tendões/cirurgia , Tecidos Suporte/química , Animais , Produtos Biológicos/química , Fenômenos Biomecânicos , Adesão Celular , Linhagem Celular , Proliferação de Células , Humanos , Regeneração , Relação Estrutura-Atividade , Propriedades de Superfície , Engenharia Tecidual
17.
J Glaucoma ; 29(5): e31-e32, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32097257

RESUMO

An 88-year-old woman with a history of recent complicated pacemaker insertion presented with acute-onset malignant glaucoma recalcitrant to conservative medical therapy. Surgical intervention was discussed; however, given her complex cardiac history and recent postoperative state, the risk of anesthesia-related systemic adverse events was deemed unacceptably high. As such, a slit-lamp procedure was recommended to break the attack of malignant glaucoma. Here within, we report a novel technique of breaking an attack of malignant glaucoma by needling the anterior hyaloid face at the slit lamp. With this technique, a 25-G needle was entered through the pars plana and was advanced through the anterior hyaloid face, zonules, and peripheral iridotomy to create a unicameral eye and successfully break the malignant closure attack.


Assuntos
Agulhamento Seco/métodos , Glaucoma de Ângulo Fechado/cirurgia , Iridectomia/métodos , Ligamentos/cirurgia , Corpo Vítreo/cirurgia , Idoso de 80 Anos ou mais , Feminino , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Glaucoma de Ângulo Fechado/fisiopatologia , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Microscopia Acústica , Lâmpada de Fenda
18.
J Med Case Rep ; 14(1): 17, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31969190

RESUMO

BACKGROUND: Necrosis of the falciform and round ligaments is extremely rare, thus making the diagnosis challenging. It is often misdiagnosed as gallbladder pathology due to the presenting symptoms. Due to the rarity of this pathology, there is limited literature available. CASE PRESENTATION: A 53-year-old white man presented to our hospital with signs and symptoms of gallbladder pain but turned out to have the rare entity of necrosis of the falciform and round ligaments. An extensive review of the world literature was performed using PubMed. Manual cross-referencing of reference lists was performed to obtain all available articles. The personal operative log of the senior author was also searched to reveal one additional case. Statistical analysis was descriptive only, given the small number of reported cases. Thirty-nine articles were found, among which forty-three case were identified, and one additional case was extracted from the operative log of the senior author. Unlike previous reports, we found that isolated inflammation and necrosis of the ligaments occurs at nearly the same frequency in both men and women, not predominantly in women as previously reported in smaller series. The mean age at presentation was 59.5 years old, and cases were typically initially diagnosed as gallbladder pathology, most commonly acute cholecystitis. Computed tomography more frequently than ultrasound revealed the falciform and round-ligament pathology. CONCLUSIONS: Isolated falciform and round-ligament inflammation and necrosis is a rare condition that is difficult to diagnose because it can present mimicking a wide variety of intra-abdominal pathologies, particularly gallbladder pathologies. It is often best treated by laparoscopic resection. Unlike prior reports, our review of the literature, which is the largest that we know of to date, shows that males and females are equally affected. Greater awareness of this entity will aid in future diagnosis.


Assuntos
Parede Abdominal/patologia , Inflamação/diagnóstico , Ligamentos/patologia , Necrose/diagnóstico , Ligamentos Redondos/patologia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/cirurgia , Diagnóstico Diferencial , Feminino , Vesícula Biliar/patologia , Humanos , Laparoscopia , Ligamentos/diagnóstico por imagem , Ligamentos/cirurgia , Masculino , Pessoa de Meia-Idade , Ligamentos Redondos/diagnóstico por imagem , Ligamentos Redondos/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia
19.
Chin J Traumatol ; 23(1): 56-59, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31980235

RESUMO

PURPOSE: Iatrogenic coracoid and clavicle fracture is a known complication of drilling bone tunnels during anatomic coracoclavicular ligament reconstruction (ACCR). This study aims to measure the dimensions of coracoid process and clavicle in an Asian population to evaluate the suitability of drilling coracoid and clavicle tunnels for ACCR in Asians. METHODS: Width measurements of 196 coracoids and 189 clavicles were obtained after reviewing all computed tomography (CT) scans of the shoulder performed over a 6 years period. Coracoid measurements were made on the CT slice which showed the maximum cross sectional width of the coracoid base. Medial to lateral measurements of the coracoid width were taken on an axial view, 4 mm above the identified junction of the coracoid base and glenoid base. Antero-posterior clavicle width was measured through a point directly above the midpoint of the coracoid and perpendicular to the long axis of the clavicle. RESULTS: The overall mean coracoid width was 14.8 mm ± 2.54 mm (range 9.2-23.3 mm) and clavicle width was 17.1 mm ± 2.72 mm (range 11.1-25.3 mm). CONCLUSION: The Asian coracoid process is smaller than its Western equivalent. More research is required to validate this conclusion as no cadaveric studies with equivalent measurement techniques have been performed on Asians. Given the potentially narrower dimensions of the Asian coracoid process, extra precautions are required to minimize the risk of iatrogenic coracoid and clavicle fractures.


Assuntos
Clavícula/anatomia & histologia , Clavícula/diagnóstico por imagem , Processo Coracoide/anatomia & histologia , Processo Coracoide/diagnóstico por imagem , Ligamentos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Grupo com Ancestrais do Continente Asiático , Clavícula/cirurgia , Processo Coracoide/cirurgia , Fraturas Ósseas/prevenção & controle , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Tomografia Computadorizada por Raios X
20.
J Zoo Wildl Med ; 50(4): 997-999, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926535

RESUMO

A single incision laparoscopic system (SILS) was used to remove the falciform ligament of an adult male cheetah (Acinonyx jubatus) during routine diagnostic liver biopsy. Adipose tissue isolated from the falciform ligament was used to establish a mesenchymal stem cell culture. The use of a SILS port for liver biopsy and falciform ligament collection allowed for a large amount of fat to be collected from a small surgical incision and rapid postoperative recovery. This case expands the use of the single incision laparoscopy surgical technique beyond reproductive sterilization procedures in large cats.


Assuntos
Acinonyx/cirurgia , Laparoscopia/veterinária , Ligamentos/cirurgia , Tecido Adiposo/citologia , Animais , Biópsia/instrumentação , Biópsia/métodos , Biópsia/veterinária , Fígado/patologia , Masculino , Células-Tronco Mesenquimais
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