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1.
Vestn Otorinolaringol ; 86(3): 41-45, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34269022

RESUMO

The features of impedance audiometry with a 226 Hz probe frequency in newborns and children in the first months of life after acute otitis media were analyzed. The age dynamics of tympanograms in children in the first year of life is determined.


Assuntos
Otite Média com Derrame , Otite Média , Testes de Impedância Acústica , Audiometria , Criança , Humanos , Recém-Nascido , Microcirurgia , Otite Média/diagnóstico
2.
Medicine (Baltimore) ; 100(25): e26352, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160402

RESUMO

BACKGROUND: The best therapeutic option for unruptured brain arteriovenous malformations (bAVMs) patients is disputed. OBJECTIVE: To assess the occurrence of obliteration and complications of patients with unruptured bAVMs after various treatments. METHODS: A systematic literature search was performed in PubMed, EMBASE, Web of Science, and so on to identify studies fulfilling predefined inclusion criteria. Baseline, treatment, and outcomes data were extracted for statistical analysis. RESULTS: We identified 28 eligible studies totaling 5852 patients. The obliteration rates were 98% in microsurgery group (95% confidence interval (CI): 96%-99%, I2 = 74.5%), 97% in surgery group (95%CI: 95%-99%, I2 = 18.3%), 87% in endovascular treatment group (95%CI: 80%-93%, I2 = 0.0%), and 68% in radiosurgery group (95%CI: 66%-69%, I2 = 92.0%). The stroke or death rates were 1% in microsurgery group (95%CI: 0%-2%, I2 = 0.0%), 0% in surgery group (95%CI: 0%-1%, I2 = 0.0%), 4% in endovascular treatment group (95%CI: 0%-8%, I2 = 85.8%), and 3% in radiosurgery group (95%CI: 3%-4%, I2 = 82.9%). In addition, the proportions of hemorrhage were 2% in microsurgery group (95%CI: 1%-4%, I2 = 0.0%), 23% in endovascular treatment group (95%CI: 7%-39%), and 12% in radiosurgery group (95%CI: 12%-13%, I2 = 99.2%). As to neurological deficit, the occurrence was 9% in microsurgery group (95%CI: 6%-11%, I2 = 94.1%), 20% in surgery group (95%CI: 13%-27%, I2 = 0.0%), 14% in endovascular treatment group (95%CI: 10%-18%, I2 = 64.0%), and 8% in radiosurgery group (95%CI: 7%-9%, I2 = 66.6%). CONCLUSIONS: We found that microsurgery might provide lasting clinical benefits in some unruptured bAVMs patients for its high obliteration rates and low hemorrhage. These findings are helpful to provide a reference basis for neurosurgeons to choose the treatment of patients with unruptured bAVMs.


Assuntos
Malformações Arteriovenosas Intracranianas/cirurgia , Hemorragias Intracranianas/epidemiologia , Procedimentos Neurocirúrgicos/métodos , Acidente Vascular Cerebral/epidemiologia , Procedimentos Endovasculares/efeitos adversos , Humanos , Malformações Arteriovenosas Intracranianas/mortalidade , Hemorragias Intracranianas/etiologia , Metanálise como Assunto , Microcirurgia/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Radiocirurgia/efeitos adversos , Acidente Vascular Cerebral/etiologia , Revisões Sistemáticas como Assunto , Resultado do Tratamento
3.
J Clin Neurosci ; 89: 264-270, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119279

RESUMO

Majority of the published literature on the impact of microsurgery over quality-of-life (QOL) in vestibular schwannoma (VS) patients is retrospective in nature, with variable results, and there has been very little contribution from South-Asia. The authors designed this study to investigate the role of microsurgery in QOL alterations in VS patients, and to compare obtained QOL scores with that of control population. Between February 2017 and March 2018, a prospective/retrospective study was done at our institute. Prospective and retrospective cohorts included, 30 and 34 consecutive patients, respectively, of unilateral VS undergoing microsurgery. QOL assessment was done using Short Form-36 (SF-36), and the Penn Acoustic Neuroma Quality-Of-Life (PANQOL) questionnaires. Prospective cohort underwent QOL assessment at 3 junctures - pre-surgery, 3-months & 1-year post-surgery; while retrospective cohort was assessed only once, at 1-year post-surgery. Age- & sex- matched normal population and diabetic patients were used as controls. In the prospective cohort, patients showed drop in all PANQOL domain/ SF-36 dimension scores at 3-month post-surgery, exception being vitality and general health in SF-36; showed improvement at 1-year follow-up, with majority either levelling or improving their respective pre-surgery scores. Gross total resection, tumors ≤ 3 cm, and age ≤ 45 years had better PANQOL scores at 1-year post-surgery across all the domains. Patients in both the cohorts showed worse QOL compared to normal population, but the gap got narrower at 1-year post-surgery. Our study adds a South-Asian perspective to the pool of prospective knowledge available on QOL following microsurgery in VS patients.


Assuntos
Microcirurgia/efeitos adversos , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Adulto , Idoso , Ásia , Estudos de Coortes , Humanos , Masculino , Microcirurgia/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários , Centros de Atenção Terciária/estatística & dados numéricos
4.
J Clin Neurosci ; 89: 319-328, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119287

RESUMO

Intradural petrous bone drilling has become a widespread practice, providing extended exposure in the removal of cerebellopontine angle (CPA) or petroclival tumors. Adjacent neurovascular structures are at risk, however, when drilling is performed in this deep and narrow area. Hence, this study evaluates the use of Piezosurgery (PS) as a non-rotating tool for selective bone cutting in CPA surgery. A Piezosurgery® device was used in 36 patients who underwent microsurgery for extra-axial CPA or petroclival tumors in our Neurosurgical Department between 2013 and 2019. The clinical and radiological data were retrospectively analyzed. The use of PS was evaluated with respect to the intraoperative applicability and limitations as well as efficacy and safety of the procedure. Piezosurgical petrous bone cutting was successfully performed in the removal of meningiomas or extra-axial metastases arising from the dura of the petroclival region (21 patients) or petrous bone (15 patients). PS proved to be very helpful in the deep and narrow CPA region, considerably reducing the surgeon's distress toward bone removal in close proximity to cranial nerves and vessels in comparison to common rotating drills. The use of PS was safe without injuries to neurovascular structures. Gross total resection was achieved in 67% of petroclival and 100% of petrous bone tumors. Piezosurgery proved to be an effective and safe method for selective petrous bone cutting in CPA surgery avoiding rotating power and associated risks. This technique can particularly be recommended for bone cutting in close vicinity to critical neurovascular structures.


Assuntos
Ângulo Cerebelopontino/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Osso Petroso/cirurgia , Piezocirurgia/métodos , Neoplasias da Base do Crânio/cirurgia , Adulto , Dura-Máter/cirurgia , Humanos , Masculino , Microcirurgia/efeitos adversos , Microcirurgia/instrumentação , Microcirurgia/métodos , Pessoa de Meia-Idade , Piezocirurgia/efeitos adversos , Piezocirurgia/instrumentação , Estudos Retrospectivos
5.
J Clin Neurosci ; 89: 226-231, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119272

RESUMO

We describe the anatomical landmarks and surgical feasibility of a novel 'safe' brainstem entry zone to approach ventrally placed intra-axial midbrain tumors. The anatomy of the brainstem was specifically studied to evaluate safe surgical entry zone in the midbrain on two formalin fixed silicon injected cadaver head specimens. A novel entry point through the lateral one - fifth of the cerebral peduncle was identified to be 'safe' to approach lesions of the ventral midbrain. Three patients, having oculomotor schwannoma, peduncular glioma and a peduncular cavernoma were operated using this safe entry zone. To approach the midbrain, retrosigmoid lateral supracerebellar route was used in two patients and a basal subtemporal avenue was deployed in one patient. On the basis of fine microanatomical dissection on cadavers, a novel entry point through the lateral one-fifth of the cerebral peduncle, 5 mm anterior to the lateral mesencephalic sulcus and approximately 5 mm superior to the fourth nerve was identified. The proposed brainstem entry point traverses the parieto-temporo-occipital pontine fibers and the trajectory is between the corticospinal tracts ventrally and the substantia nigra dorsally. Three patients were operated successfully using the approach. There were no post-operative motor, sensory or extra-pyramidal deficits. The corridor through the lateral one-fifth of the cerebral peduncle presents a safe and relative 'easy' surgical route to approach ventrally placed intra-axial midbrain tumors.


Assuntos
Neoplasias do Tronco Encefálico/diagnóstico por imagem , Neoplasias do Tronco Encefálico/cirurgia , Pedúnculo Cerebral/diagnóstico por imagem , Pedúnculo Cerebral/cirurgia , Craniotomia/métodos , Microcirurgia/métodos , Adulto , Cadáver , Feminino , Humanos , Masculino , Adulto Jovem
6.
Neurol India ; 69(3): 578-581, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34169845

RESUMO

Vestibular schwannoma surgery is a challenging operative procedure. Intricate anatomy of vital neurovascular structures demands a meticulous planning and execution. The cerebellopontine angle is an unforgiving area of skull bases surgery which can have grave implications on patient outcome even after a successful tumor removal. As more and more tumors are being detected at early stage, functional preservation of seventh and eighth nerve complex is increasingly being demanded. The key to any minimally invasive approach is to minimize the collateral damage while ensuring complete tumor removal. Binocular microscopy is the workhorse for illumination and dissection via retrosigmoid approach. However, as instrumentation has improved, endoscopic dissections are increasingly being performed. The following video presents the step-by-step nuances for an endoscope-assisted microsurgery for small vestibular schwannomas with stress on endoscopic drilling of the meatal wall to deliver out intracanacular tumor while preserving the labrynthine structures.


Assuntos
Neuroma Acústico , Ângulo Cerebelopontino/cirurgia , Endoscopia , Humanos , Microcirurgia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos
7.
J Laryngol Otol ; 135(5): 420-425, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952362

RESUMO

OBJECTIVE: Tympanostomy is one of the most commonly performed surgical procedures in otolaryngology, and its complexity is challenging for trainee surgeons. Investing in medical education is a cornerstone of good patient safety practices. For trainees, use of simulators before operating on actual patients helps mitigate risks. This study aimed to develop a three-dimensional printed model simulator for myringotomy, tympanostomy and ventilation tube placement. METHODS: An articulated model with a detachable portion, base and plastic bag to simulate the external auditory canal, middle ear and tympanic membrane, respectively, was modelled and printed. RESULTS: The final simulator was made from acrylonitrile butadiene styrene polymer and measured 4 × 4 × 12 cm. It was designed to mimic the angulation of patient anatomy in the myringotomy position and simulate the texture and colour of the tissues of interest. The cost was low, and testing with an operating microscope and endoscope yielded satisfactory results. The advent of three-dimensional printing technology has made surgical simulation more accessible and less expensive, providing several advantages for medical education. CONCLUSION: The proposed model fulfilled expectations as a safe, inexpensive, reproducible, user-friendly and accessible surgical education tool that can be improved and reassessed for further research.


Assuntos
Endoscopia/educação , Microcirurgia/educação , Ventilação da Orelha Média/educação , Modelos Anatômicos , Impressão Tridimensional , Treinamento por Simulação , Adulto , Criança , Pré-Escolar , Competência Clínica , Humanos , Internato e Residência
8.
Cochrane Database Syst Rev ; 5: CD013312, 2021 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-33971026

RESUMO

BACKGROUND: Unruptured intracranial aneurysms are relatively common lesions in the general population, with a prevalence of 3.2%, and are being diagnosed with greater frequency as non-invasive techniques for imaging of intracranial vessels have become increasingly available and used. If not treated, an intracranial aneurysm can be catastrophic. Morbidity and mortality in aneurysmal subarachnoid hemorrhage are substantial: in people with subarachnoid hemorrhage, 12% die immediately, more than 30% die within one month, 25% to 50% die within six months, and 30% of survivors remain dependent. However, most intracranial aneurysms do not bleed, and the best treatment approach is still a matter of debate. OBJECTIVES: To assess the risks and benefits of interventions for people with unruptured intracranial aneurysms. SEARCH METHODS: We searched CENTRAL (Cochrane Library 2020, Issue 5), MEDLINE Ovid, Embase Ovid, and Latin American and Caribbean Health Science Information database (LILACS). We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform from inception to 25 May 2020. There were no language restrictions. We contacted experts in the field to identify further studies and unpublished trials. SELECTION CRITERIA: Unconfounded, truly randomized trials comparing conservative treatment versus interventional treatments (microsurgical clipping or endovascular coiling) and microsurgical clipping versus endovascular coiling for individuals with unruptured intracranial aneurysms. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion according to the above criteria, assessed trial quality and risk of bias, performed data extraction, and applied the GRADE approach to the evidence. We used an intention-to-treat analysis strategy. MAIN RESULTS: We included two trials in the review: one prospective randomized trial involving 80 participants that compared conservative treatment to endovascular coiling, and one randomized controlled trial involving 136 participants that compared microsurgical clipping to endovascular coiling for unruptured intracranial aneurysms. There was no difference in outcome events between conservative treatment and endovascular coiling groups. New perioperative neurological deficits were more common in participants treated surgically (16/65, 24.6%; 15.8% to 36.3%) versus 7/69 (10.1%; 5.0% to 19.5%); odds ratio (OR) 2.87 (95% confidence interval (CI) 1.02 to 8.93; P = 0.038). Hospitalization for more than five days was more common in surgical participants (30/65, 46.2%; 34.6% to 58.1%) versus 6/69 (8.7%; 4.0% to 17.7%); OR 8.85 (95% CI 3.22 to 28.59; P < 0.001). Clinical follow-up to one year showed 1/48 clipped versus 1/58 coiled participants had died, and 1/48 clipped versus 1/58 coiled participants had become disabled (modified Rankin Scale > 2). All the evidence is of very low quality. AUTHORS' CONCLUSIONS: There is currently insufficient good-quality evidence to support either conservative treatment or interventional treatments (microsurgical clipping or endovascular coiling) for individuals with unruptured intracranial aneurysms. Further randomized trials are required to establish if surgery is a better option than conservative management, and if so, which surgical approach is preferred for which patients. Future studies should include consideration of important characteristics such as participant age, gender, aneurysm size, aneurysm location (anterior circulation and posterior circulation), grade of ischemia (major stroke), and duration of hospitalizations.


Assuntos
Tratamento Conservador , Aneurisma Intracraniano/terapia , Microcirurgia/métodos , Stents , Término Precoce de Ensaios Clínicos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/etiologia
9.
Cochrane Database Syst Rev ; 5: CD012802, 2021 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049422

RESUMO

BACKGROUND: Glaucoma is the leading cause of global irreversible blindness, often associated with raised intraocular pressure (IOP). Where medical or laser treatment has failed or is not tolerated, surgery is often required. Minimally-invasive surgical approaches have been developed in recent years to reduce IOP with lower surgical risks. Supraciliary microstent surgery for the treatment of open-angle glaucoma (OAG) is one such approach. OBJECTIVES: To evaluate the efficacy and safety of supraciliary microstent surgery for the treatment of OAG, and to compare with standard medical, laser or surgical treatments. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2020, Issue 8); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 27 August 2020. SELECTION CRITERIA: We searched for randomised controlled trials (RCTs) of supraciliary microstent surgery, alone or with cataract surgery, compared to other surgical treatments (cataract surgery alone, other minimally invasive glaucoma device techniques, trabeculectomy), laser treatment or medical treatment. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts from the database search to identify studies that met the selection criteria. Data extraction, analysis, and evaluation of risk of bias from selected studies was performed independently and according to standard Cochrane methodology. MAIN RESULTS: One study met the inclusion criteria of this review, evaluating the efficacy and safety of the Cypass supraciliary microstent surgery for the treatment of OAG, comparing phacoemulsification + supraciliary microstent surgery with phacoemulsification alone over 24 months. This study comprised 505 eyes of 505 participants with both OAG and cataract, 374 randomised to the phacoemulsification + microstent group.  In this study, the perceived risk of bias from random sequence generation, allocation concealment and selective reporting was low. However, we considered the study to be at high risk of performance bias as surgeons/investigators were unmasked. Attrition bias was unclear, with 448/505 participants contributing to per protocol analysis. Insertion of a Cypass supraciliary microstent combined with phacoemulsification probably increases the proportion of participants who are medication-free (not using eye-drops) at 24 months compared with phacoemulsification alone (85% versus 59%, risk ratio (RR) 1.27, 95% confidence interval (CI) 1.09 to 1.49, moderate-certainty evidence). There is high-certainty evidence that a greater improvement in mean IOP occurs in the phacoemulsification + microstent group - mean (SD) change in IOP from baseline of -5.4 (3.9) mmHg in the phacoemulsification group, compared to -7.4 (4.4) mmHg in the phacoemulsification + microstent group at 24 months (mean difference -2.0 mmHg, 95% CI -2.85 to -1.15). There is moderate-certainty evidence that insertion of a microstent is probably associated with a greater reduction in use of IOP-lowering drops (mean reduction of 0.7 medications in the phacoemulsification group, compared to a mean reduction of 1.2 medications in the phacoemulsification + microstent group). Insertion of a microstent during phacoemulsification may reduce the requirement for further glaucoma intervention to control IOP at a later stage compared to phacoemulsification alone (RR 0.26, 95% CI 0.07 to 1.04, low-certainty evidence). There is no evidence relating to the rate of visual field progression, or proportion of participants whose visual field loss progressed in this study. There is moderate-certainty evidence showing little or no difference in the proportion of participants experiencing postoperative complications over 24 months between participants in the microstent group compared to those who received phacoemulsification alone (RR 1.1, 95% CI 0.8 to 1.4). Five year post-approval data regarding the safety of the Cypass supraciliary microstent showed increased endothelial cell loss, associated with the position of the microstent in the anterior chamber. There were no reported health-related quality of life (HRQoL) outcomes in the included study. AUTHORS' CONCLUSIONS: Data from this single RCT show superiority of supraciliary microstent surgery when combined with phacoemulsification compared to phacoemulsification alone in achieving medication-free control of OAG. However, there are long-term safety concerns with the device used in this trial, relating to the observed significant loss of corneal endothelial cells at five years following device implantation. At the time of this review, this device has been withdrawn from the market. This review has found that few high-quality studies exist comparing supraciliary microstent surgery to standard medical, laser or surgical glaucoma treatments. This should be addressed by further appropriately designed RCTs with sufficient long-term follow-up to ensure robust safety data are obtained. Consideration of health-related quality of life outcomes should also feature in trial design.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Microcirurgia/instrumentação , Facoemulsificação/métodos , Stents , Viés , Terapia Combinada/métodos , Perda de Células Endoteliais da Córnea/etiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents/efeitos adversos
10.
Transplant Proc ; 53(5): 1645-1652, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34001348

RESUMO

Aberrant donor hepatic artery anatomy or hepatic artery injury during organ procurement or recipient preparation poses a surgical challenge during deceased donor liver transplantation. In this study, we aimed to investigate arterial reconstruction using microvascular techniques during deceased donor liver transplantation and suggest reasonable indications for the microsurgical approach in this setting. We retrospectively reviewed the outcomes of 470 deceased donor liver transplantations performed at our institution between July 2011 and December 2015. Of these, 128 recipients underwent microsurgical hepatic artery reconstruction and 342 underwent reconstruction with surgical loupes. Thirty-two patients (6.8%) experienced hepatic artery-related complications, including hepatic artery thrombosis (n = 8, 1.7%). In the propensity score-matched cohort, the surgical loupe group showed a higher complication rate (P = .782). On multivariate analysis, cold ischemia time (odds ratio, 0.995; 95% confidence interval, 0.9920-0.999; P = .009) and use of aortohepatic conduits (odds ratio, 5.254; 95% confidence interval, 1.878-14.699; P = .002) were independent predictors of arterial complications. The low incidence of hepatic artery complications in this study is likely attributable to the active application of microsurgical techniques. Active application of back-table microsurgical plasty and selective application of microsurgical techniques for main arterial reconstruction may help minimize operative difficulties and arterial complications.


Assuntos
Artéria Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Trombose/etiologia , Adulto , Estudos de Coortes , Isquemia Fria , Feminino , Humanos , Incidência , Masculino , Microcirurgia , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Procedimentos Cirúrgicos Vasculares/efeitos adversos
11.
BMJ Case Rep ; 14(5)2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34045200

RESUMO

A 25-year-old man presented with left-sided hearing loss, blurred vision and papilloedema. Imaging revealed a large, left-sided, contrast-enhancing cerebellopontine mass causing obstructive hydrocephalus, consistent with vestibular schwannoma (VS). Following an incomplete resection via retrosigmoid craniotomy at an outside facility, he was referred to our department, and cerebrospinal fluid diversion followed by repeat resection was recommended. A subtotal resection was achieved, and the patient was subsequently treated with adjuvant stereotactic radiosurgery (SRS). Progressive interval growth was observed on serial post-SRS MRI studies; correspondingly, at 31 months after treatment, the patient was initiated on antiprogrammed-death receptor 1 (PD-1) antibody treatment with pembrolizumab. Growth arrest was noted on subsequent serial imaging studies, which have been maintained for a total of 30 months since initiation of a 18-month anti-PD-1 course of therapy. Additional case accumulation and translational study is required to better characterise this therapeutic strategy; however, PD-1/programmed death-ligand 1 inhibition may offer a promising salvage therapy for refractory VS.


Assuntos
Neuroma Acústico , Radiocirurgia , Adulto , Craniotomia , Humanos , Masculino , Microcirurgia , Neuroma Acústico/tratamento farmacológico , Neuroma Acústico/cirurgia , Radiocirurgia/efeitos adversos , Terapia de Salvação , Resultado do Tratamento
12.
BMC Med Educ ; 21(1): 295, 2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34024279

RESUMO

BACKGROUND: Microsurgical techniques are an important part of clinical and experimental research. Here we present our step-by-step microsurgery training course developed at the Münster University Hospital. The goal of this course was to create a short, modular curriculum with clearly described and easy to follow working steps in accordance with the Guidelines for Training in Surgical Research in Animals by the Academy of Surgical Research. METHODS: Over the course of 10 years, we conducted an annual 2.5 day (20 h) microsurgical training course with a total of 120 participants. RESULTS: Prior to the course, 90% of the participants reported to have never performed a microanastomosis before. During the 10 years a total of 84.2% of the participants performed microanastomoses without assistance, 15% required assistance and only 0.8% failed. CONCLUSIONS: Our step-by-step microsurgery training course gives a brief overview of the didactic basics and the organization of a microsurgical training course and could serve as a guide for teaching microsurgical skills. During the 2.5-day curriculum, it was possible to teach, and for participants to subsequently perform a microsurgical anastomosis. The independent reproducibility of the learned material after the course is not yet known, therefore further investigations are necessary. With this step-by-step curriculum, we were able to conduct a successful training program, shown by the fact that each participant is able to perform microvascular anastomoses on a reproducible basis.


Assuntos
Currículo , Microcirurgia , Anastomose Cirúrgica , Animais , Competência Clínica , Hospitais Universitários , Humanos , Reprodutibilidade dos Testes
13.
J Clin Neurosci ; 88: 135-141, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33992172

RESUMO

The study aimed to assess the effect of exogenous factors such as surgeon posture, surgical instrument length, fatigue after a night shift, exercise and caffeine consumption on the spatial accuracy of neurosurgical manipulations. For the evaluation and simulation of neurosurgical manipulations, a testing device developed by the authors was used. The experimental results were compared using nonparametric analysis (Wilcoxon test) and multivariate analysis, which was performed using mixed models. The results were considered statistically significant at p < 0.05. The study included 11 first-year neurosurgery residents who met the inclusion criteria. Hand support in the sitting position (Wilcoxon test p value = 0.0033), caffeine consumption (p = 0.0058) and the length of the microsurgical instrument (p = 0.0032) had statistically significant influences on the spatial accuracy of surgical manipulations (univariate analysis). The spatial accuracy did not significantly depend on the type of standing position (Wilcoxon test p value = 0.2860), whether the surgeon was standing/sitting (p = 0.1029), fatigue following a night shift (p = 0.3281), or physical exertion prior to surgery (p = 0.2845). When conducting the multivariate analysis, the spatial accuracy significantly depended on the test subject (p < 0.0001), the use of support during the test (p = 0.0001), and the length of the microsurgical instrument (p = 0.0397). To increase the spatial accuracy of microsurgical manipulations, hand support and shorter tools should be used. Caffeine consumption in high doses should also be avoided prior to surgery.


Assuntos
Competência Clínica , Neurocirurgia , Procedimentos Neurocirúrgicos , Desempenho Psicomotor , Simulação por Computador , Humanos , Microcirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Postura , Cirurgiões , Instrumentos Cirúrgicos
15.
J Laryngol Otol ; 135(5): 410-414, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33883045

RESUMO

OBJECTIVE: This study aimed to compare the necessary scutum defect for transmeatal visualisation of middle-ear landmarks between an endoscopic and microscopic approach. METHOD: Human cadaveric heads were used. In group 1, middle-ear landmarks were visualised by endoscope (group 1 endoscopic approach) and subsequently by microscope (group 1 microscopic approach following endoscopy). In group 2, landmarks were visualised solely microscopically (group 2 microscopic approach). The amount of resected bone was evaluated via computed tomography scans. RESULTS: In the group 1 endoscopic approach, a median of 6.84 mm3 bone was resected. No statistically significant difference (Mann-Whitney U test, p = 0.163, U = 49.000) was found between the group 1 microscopic approach following endoscopy (median 17.84 mm3) and the group 2 microscopic approach (median 20.08 mm3), so these were combined. The difference between the group 1 endoscopic approach and the group 1 microscopic approach following endoscopy plus group 2 microscopic approach (median 18.16 mm3) was statistically significant (Mann-Whitney U test, p < 0.001, U = 18.000). CONCLUSION: This study showed that endoscopic transmeatal visualisation of middle-ear landmarks preserves more of the bony scutum than a microscopic transmeatal approach.


Assuntos
Orelha Média/diagnóstico por imagem , Orelha Média/cirurgia , Endoscopia , Microcirurgia , Procedimentos Cirúrgicos Otológicos , Cadáver , Humanos , Imageamento Tridimensional , Tomografia Computadorizada por Raios X
16.
J Endod ; 47(7): 1052-1060, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33901547

RESUMO

INTRODUCTION: The purpose of this study was to evaluate the effect of the piezoelectric device on intraoperative hemorrhage control during surgery and the quality of life of patients after endodontic microsurgery. METHODS: A total of 40 patients were randomly divided into the piezo group (n = 20) and the control group (n = 20). In the piezo group, after flap reflection, bone cutting, granulation tissue removal, and root-end resection were performed using the piezoelectric surgical device and surgical carbide burs, and curettes were used in the control group. The quality of life of patients was evaluated daily for 1 week postsurgery for limitations of oral and general functions, pain, and other symptoms. Limitation of functions and other symptoms were recorded by a modified version of the patient's perception questionnaire using a 5-point Likert scale for mouth opening, chewing, speaking, sleeping, daily routine, missed work, swelling, nausea, and bad taste/breath, and the visual analog scale was adopted for pain. Hemorrhage control during surgery was independently assessed by the surgeon and 2 blinded observers and recorded as 0 (no hemorrhage control), 1 (intermittent control), and 2 (complete control). The chi-square test was used to assess hemorrhage control. For variables related to function and symptoms other than pain and analgesics taken, the Fisher exact test was used. For the assessment of pain between the 2 groups, the Mann-Whitney U test was used. RESULTS: For parameters of quality of life, the piezo group showed significantly less swelling on the first, second, and third days and pain on the first and second days compared with the control group (P < .05). Analgesics taken were also significantly less in the piezo group (P < .05). In the piezo group, complete hemorrhage control was achieved in 10 patients, and in the control group, it was achieved only in 1 patient (P < .05). CONCLUSIONS: Piezoelectric surgery resulted in improved quality of life of patients in the first week postsurgery with lower levels of pain and swelling as well as the number of analgesics taken and better hemorrhage control during surgery.


Assuntos
Microcirurgia , Qualidade de Vida , Apicectomia , Hemorragia , Humanos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Inquéritos e Questionários
17.
Ophthalmologe ; 118(7): 741-746, 2021 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-33877403

RESUMO

In the 1970s a cutting device into which an infusion and an aspiration channels were integrated, the so-called vitreous infusion suction cutter (V.I.S.C), was used for the first time for the removal of the vitreous body. These cutting systems have continued to constantly evolve since then; however, sonic energy remained reserved for anterior segment surgery for a long time. In 2020, this form of energy could also be used for the posterior segment in form of Vitesse™. In this liquification technique, ultrasonic energy is transferred to a single, large inner lumen design that mechanically vibrates the needle's port. These high-speed vibrations shear the vitreous body at the port edges before it enters the needle. This mechanism reduces traction to a minimal level and enables faster aspiration at lower vacuum levels compared to conventional cutters. These advantages can promote a safer and more efficient vitreoretinal surgery.


Assuntos
Vitrectomia , Corpo Vítreo , Humanos , Microcirurgia , Sucção , Tecnologia , Corpo Vítreo/cirurgia
18.
Ann Palliat Med ; 10(5): 5027-5045, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33894717

RESUMO

BACKGROUND: The aim of this study was to analyze the outcome and prognostic factors of root canal treatment (RCT) and endodontic microsurgery (EMS) in the treatment of apical periodontitis (AP), respectively, and to compare the outcome and prognostic factors between initial RCT and nonsurgical retreatment (re-RCT) for AP. METHODS: Patients with AP were recruited from the Stomatology Department of Peking University Third Hospital from January 2016 to December 2019. Data were collected by medical records review. Univariate analysis of treatment outcome was performed for the total RCT group, initial RCT group, re-RCT group and EMS group, respectively. Multivariate logistic regression was performed for the three RCT groups, respectively, but not for the EMS group. RESULTS: The overall success of treatment for AP was 73.8%. The success rate of RCT in 229 cases was 70.7%, while that of EMS in 34 cases was 94.1%. The failure of RCT was significantly higher for elderly patients [odds ratio (OR) =1.025, P=0.013], teeth with incomplete fracture (OR =7.082, P=0.013), teeth with a greater crown root ratio (OR =1.198, P=0.029), teeth treated by a general dentist (OR =2.16, P=0.042) and teeth with unqualified treatment (OR =2.841, P=0.002). Of the 166 teeth treated by initial RCT, the success was 68.1%. A greater crown root ratio (OR =1.333, P=0.004) was identified as a risk factor for treatment. Of the 63 teeth treated by re-RCT, the success was 77.8%. A lower success was observed in teeth with unqualified treatment (OR =5.291, P=0.018). With regard to EMS, the univariate analysis showed that none of the variables were significantly related to the outcome. CONCLUSIONS: For AP treated by RCT, age, incomplete tooth fracture, crown root ratio, doctor classification and unqualified treatment had a strong impact on determining outcome. For initial RCT, crown root ratio was a significant outcome predictor, while for re-RCT, unqualified treatment was a strong statistically significant factor. No significant difference was found between the success of initial RCT and re-RCT for AP.


Assuntos
Microcirurgia , Periodontite Periapical , Idoso , Estudos de Coortes , Cavidade Pulpar , Humanos , Periodontite Periapical/terapia , Tratamento do Canal Radicular
19.
J Stroke Cerebrovasc Dis ; 30(7): 105821, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33915389

RESUMO

OBJECTIVES: The purpose of this study was to investigate the risk factors associated with recurrence of posterior communicating artery aneurysms after treatment and to evaluate the significance of fetal-type posterior cerebral artery as an independent risk factor for recurrence of posterior communicating artery aneurysms. MATERIALS AND METHODS: The clinical and radiological findings of 220 posterior communicating artery aneurysms treated between January 2009 and December 2016 in a single tertiary institute were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the association between clinical and radiological variables and recurrence. RESULTS: Of 220 posterior communicating artery aneurysms, 148 aneurysms were unruptured and 82 aneurysms were treated with surgery. Forty-six out of 220 aneurysms (20.9%) were associated with fetal-type posterior cerebral artery. Overall recurrence rate was 19% (42 out of 220 aneurysms) during mean 54.6 ± 29.8 months follow-up. Multivariate logistic regression analysis showed that size (OR=1.238; 95% CI, 1.087-1.409, p = 0.001), ruptured status (OR=2.699; 95% CI, 1.179-6.117, p = 0.019), endovascular treatment (OR=3.803; 95% CI, 1.330-10.875, p = 0.013), incomplete occlusion (OR=4.699; 95% CI, 1.999-11.048, p = <0.001) and fetal-type posterior cerebral artery (OR=3.533; 95% CI, 1.373-9.089, p = 0.009) were significantly associated with recurrence after treatment. CONCLUSIONS: The results demonstrated that fetal-type posterior cerebral artery may be an independent risk factor for the recurrence of posterior communicating artery aneurysms. Therefore, fetal-type posterior cerebral artery can be considered as an important risk factor for the recurrence of posterior communicating artery aneurysms, along with other known risk factors such as size, ruptured status, endovascular treatment, and incomplete occlusion.


Assuntos
Procedimentos Endovasculares/efeitos adversos , Aneurisma Intracraniano/cirurgia , Microcirurgia/efeitos adversos , Artéria Cerebral Posterior/anormalidades , Artéria Cerebral Posterior/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Posterior/diagnóstico por imagem , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
20.
Andrologia ; 53(6): e14066, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33866579

RESUMO

Although a wide array of interventions exist for men seeking fertility after vasectomy, up to 6% of them will elect for a vasectomy reversal. While the widespread adoption of telemedicine promises convenience and improved access, lack of ability to do a physical examination may hinder appropriate counselling. Although vasectomy reversal is successfully completed in most of the men either with a vasovasostomy or a vasoepididymostomy, there could be various reasons for the inability to successfully complete the operation. Our commentary outlines the reasons why a vasectomy reversal is not possible or successful. We also discuss a pre-operative management algorithm in men seeking vasectomy reversal to ensure appropriate counselling with a thorough pre-operative history, physical examination and on occasion, hormonal evaluation.


Assuntos
Vasectomia , Vasovasostomia , Fertilidade , Humanos , Masculino , Microcirurgia
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