Superior oblique split lengthening procedure for brown syndrome, outcomes and complications

2021 ◽  
pp. bjophthalmol-2020-317831
Author(s):  
Albanderi Alhamzah ◽  
Mozon F Alshareef ◽  
Rasha Shabar ◽  
Shatha Hussein Alfreihi
Keyword(s):  
Postoperative Complications ◽  
Surgical Outcomes ◽  
Safe Procedure ◽  
Single Institution ◽  
Vertical Deviation ◽  
Tendon Lengthening ◽  
The Mean ◽  
Brown Syndrome ◽  
Superior Oblique

IntroductionTo evaluate the outcomes of the superior oblique split tendon lengthening (SOSL) procedure for Brown syndrome (BS).MethodsAt a single institution, all patients who underwent SOSL surgery for BS from 2013 to 2019 were reviewed retrospectively. We looked at the surgical outcomes and complications in a total of 20 eyes of 18 patients. The superior oblique (SO) muscle was isolated and then extended. The tendon was then split centrally into equal halves. Two 6–0 polyglactin sutures were then placed on each end of the split tendon 6–10 mm apart. To complete the Z-cut, the split tendon was cut distal to the preplaced sutures. The sutures were then tied to produce the split Z-tendon lengthening.ResultsEleven (55%) out of 20 eyes were female patients. The mean age was 6.6 years (range 2–17 years). The mean follow-up was 26.8 months (range 5–72 months). The mean degree of preoperative limitation of elevation on adduction was −3.6±0.58 preoperatively and −0.75±1.25 postoperatively (p=0.0001). Preoperatively, the mean degree of vertical deviation at near was 3.5±7.62 and at distance was 3.10±7.84 prism diopters (PD), respectively. Postoperatively, the mean vertical deviation was 2.77±4.75 and 2.10±4.08 PD at near and distance, respectively. Postoperative complications included haematoma in one patient (5%), overcorrection in two patients (10%) and one patient required reoperation (5%).ConclusionSOSL is a safe procedure that surgeons can consider in managing patients with BS.

scholarly journals Extracapsular versus intracapsular allograft nephrectomy: impact on allosensitization and surgical outcomes

2013 ◽  
Vol 5 (1) ◽  
pp. 49 ◽  
Author(s):  
Naji J. Touma ◽  
Alp Sener ◽  
Yves Caumartin ◽  
Jeff Warren ◽  
Christopher Y. Nguan ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Loss ◽  
Surgical Outcomes ◽  
Panel Reactive Antibody ◽  
Transplant Patients ◽  
The Mean ◽  
Allograft Nephrectomy ◽  
The Impact ◽  
Reactive Antibody

Introduction: Our objective was to compare the impact of extracapsular(ECAN) versus intracapsular allograft nephrectomy (ICAN)on allosensitization and surgical outcomes.Methods: Between 1990 and 2004, 96 allograft nephrectomieswere performed at our institution. Of these, 29 procedures wereperformed within 1 month of the transplant and were thereforeomitted from analysis. Overall, the results of 44 ECAN and 23ICAN were reviewed.Results: The mean operative times were 110.9 versus 130.4 minfor ICAN versus ECAN (p = 0.02) and the estimated blood losswas 226 mL for ICAN versus 483 mL for ECAN (p = 0.004).Intraoperative and postoperative complications were low usingeither technique and differences were not statistically significant.Overall, the preoperative to postoperative change in the percentageof panel reactive antibody was +2.1% for ICAN versus +1.2% forECAN (NS) at 3 to 12 months postoperatively, respectively (NS).The percentage of patients relisted was 33.3% versus 54.3% (NS),and the percentage of patients re-transplanted once relisted wasalso very similar: 63.2% for ECAN versus 66.7% for ICAN (NS),after a mean follow-up of 4.5 and 8.4 years, respectively.Conclusions: ICAN can be performed with shorter operative timesand less blood loss versus the extracapsular approach. As well, thisoperative approach does not appear to affect allosensitization andthe ability to re-transplant patients.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

scholarly journals Modified Percutaneous Achilles Tendon Lengthening by Triple Hemisection for Achilles Tendon Contracture

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Yangjing Lin ◽  
Jin Cao ◽  
Changgui Zhang ◽  
Liu Yang ◽  
Xiaojun Duan
Keyword(s):  
Achilles Tendon ◽  
Recurrence Rate ◽  
Operative Time ◽  
Achilles Tendon Rupture ◽  
Tendon Lengthening ◽  
Group A ◽  
Achilles Tendon Lengthening ◽  
The Mean ◽  
Group B

Background. Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods. Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-five cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. The function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results. The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. The infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at final follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion. Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.

scholarly journals Isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability: analysis of outcomes and risk factors

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Filippo Migliorini ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Jörg Eschweiler ◽  
Matthias Knobe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Outcomes ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
The Mean ◽  
Tegner Score

Abstract Background The medial patellofemoral ligament (MPFL) is always damaged after patellar dislocation. In selected patients, MPFL reconstruction is necessary to restore a correct patellar tracking. Despite the large number of different techniques reported to reconstruct the MPFL, there is no consensus concerning the optimal procedure, and debates is still ongoing. The present study analysed the results after isolated MPFL reconstruction in patients with patellofemoral instability. Furthermore, a subgroup analysis of patients presenting pathoanatomical risk factors was made. Methods In November 2020, the main electronic databases were accessed. All articles reporting the results of primary isolated MPFL reconstruction for recurrent patellofemoral instability were considered for inclusion. Only articles reporting a minimum 12-month follow-up were eligible. Results Data from a total of 1777 knees were collected. The mean age of the patients involved was 22.8 ± 3.4 years. The mean follow-up was 40.7 ± 25.8 months. Overall, the range of motion (+ 27.74; P < 0.0001) and all the other scores of interests improved at last follow-up: Kujala (+ 12.76; P = 0.0003), Lysholm (+ 15.69; P < 0.0001), Tegner score (+ 2.86; P = 0.006). Seventy-three of 1780 patients (4.1%) showed a positive apprehension test. Thirty of 1765 patients (1.7%) experienced re-dislocations, while 56 of 1778 patients (3.2%) showed persisting joint instability. Twenty-five of 1786 patients (1.4%) underwent revision surgeries. Conclusion Isolated MPFL reconstruction for recurrent patellofemoral instability provides reliable surgical outcomes. Patients with pathoanatomical predisposing factors reported worse surgical outcomes.

Dynamic cranioplasty for brachycephaly in Apert syndrome: long-term follow-up study

2001 ◽  
Vol 94 (5) ◽  
pp. 757-764 ◽  
Author(s):  
José Guimarães-Ferreira ◽  
Fredrik Gewalli ◽  
Pelle Sahlin ◽  
Hans Friede ◽  
Py Owman-Moll ◽  
...  
Keyword(s):  
Cell Mass ◽  
Apert Syndrome ◽  
Long Term Results ◽  
Safe Procedure ◽  
Content Type ◽  
Skull Shape ◽  
The Mean ◽  
Fine Print

Object. Brachycephaly is a characteristic feature of Apert syndrome. Traditional techniques of cranioplasty often fail to produce an acceptable morphological outcome in patients with this condition. In 1996 a new surgical procedure called “dynamic cranioplasty for brachycephaly” (DCB) was reported. The purpose of the present study was to analyze perioperative data and morphological long-term results in patients with the cranial vault deformity of Apert syndrome who were treated with DCB. Methods. Twelve patients have undergone surgery performed using this technique since its introduction in 1991 (mean duration of follow-up review 60.2 months). Eleven patients had bicoronal synostosis and one had a combined bicoronal—bilambdoid synostosis. Perioperative data and long-term evolution of skull shape visualized on serial cephalometric radiographs were analyzed and compared with normative data. Changes in mean skull proportions were evaluated using a two-tailed paired-samples t-test, with differences being considered significant for probability values less than 0.01. The mean operative blood transfusion was 136% of estimated red cell mass (ERCM) and the mean postoperative transfusion was 48% of ERCM. The mean operative time was 218 minutes. The duration of stay in the intensive care unit averaged 1.7 days and the mean hospital stay was 11.8 days. There were no incidences of mortality and few complications. An improvement in skull shape was achieved in all cases, with a change in the mean cephalic index from a preoperative value of 90 to a postoperative value of 78 (p = 0.000254). Conclusions. Dynamic cranioplasty for brachycephaly is a safe procedure, yielding high-quality morphological results in the treatment of brachycephaly in patients with Apert syndrome.

scholarly journals Surgical outcomes of acute acquired comitant esotropia of adulthood

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dae Hyun Kim ◽  
Ha Jeong Noh
Keyword(s):  
Success Rate ◽  
Surgical Outcomes ◽  
Medical Records ◽  
Large Angle ◽  
Sudden Onset ◽  
Prism Diopter ◽  
Factors Affecting ◽  
The Mean ◽  
Motor Outcomes

Abstract Background Acute acquired comitant esotropia (AACE) is a type of strabismus characterized by a sudden onset of large angle esotropia with diplopia, which often occurs in children after infancy, teenagers, and young adolescents. However, studies on the surgical outcomes of only adults are rare. The purpose of this article is to analyze the surgical outcomes for adult patients diagnosed with AACE. Methods Medical records of 24 patients who had undergone surgery for AACE were retrospectively analyzed. The main outcome measures were the final motor and sensory success rate after surgery and factors affecting motor and sensory outcomes. Motor success was considered alignment within 8 prism diopter (PD) at both near and distance and sensory success was stereoacuity ≥ 60 sec/arc. Results The preoperative mean esodeviation angles were 33.1 ± 10.4 PD at distance and 33.3 ± 11.2 PD at near. The mean period of postoperative follow up was 7.5 ± 4.5 months (range 1–8 months). The postoperative mean esodeviation angles at final follow-up time were 3.4 ± 6.1 PD at distance and 3.8 ± 6.7 PD at near. The surgical motor success rate at final follow-up was 79.2% (19/24). The sensory success rate at final follow-up was 50.0% (12/24). The factor affecting the motor outcome was the type of surgery (p < 0.05). The factor affecting sensory outcome was postoperative follow-up time (p < 0.05). Conclusions Surgery type appears to affect surgical motor outcomes in adults with AACE. Although the sensory outcome was favorable, it seems that regaining bifoveal fixation takes time.

Surgical Outcomes and Predictive Factors of Medial Toe Excision for Polysyndactyly of the Fifth Toe

2020 ◽  
pp. 107110072097128
Author(s):  
Kyung Rae Ko ◽  
Jong Sup Shim ◽  
Jiwon Kang ◽  
Jaesung Park
Keyword(s):  
Surgical Outcomes ◽  
Proximal Phalanx ◽  
Case Series ◽  
Valgus Deformity ◽  
Retrospective Case ◽  
Functional Disturbance ◽  
Thickness Skin ◽  
Fifth Toe ◽  
The Mean

Background: We aimed to report surgical outcomes and analyze prognostic factors of medial toe excision for polysyndactyly of the fifth toe. Methods: We reviewed the details of 139 consecutive patients who underwent surgery for postaxial polydactyly of the foot from 2009 to 2018. Among these, 83 patients (90 feet) with polysyndactyly of the fifth toe, treated by medial toe excision (between the duplicated toes) and reconstruction of the fourth web space using a dorsal rectangular flap, were included. The toe alignment and stability were restored by chondroplasty and soft tissue balancing without an osteotomy. A full-thickness skin graft was performed in 52 feet. The mean age at surgery was 27.1 ± 17.5 months and the mean duration of follow-up was 42.8 ± 24.9 months. Results: At the last follow-up, a relatively small size of the reconstructed toe was observed in 19 feet (19/90, 21.1%). Proximal duplication level (metatarsal or proximal phalanx type) and preoperative hypoplasia of the remaining toe were related to the small postoperative size. Valgus deformity of the remaining toe was observed in 2 feet (2/90, 2.2%). We observed 17 cases with delayed healing or early postoperative wound infection. Among these, 7 cases (7/90, 7.8%) showed postoperative thickening or advancement of the web, which was not observed in cases without wound problems. No cases had functional disturbance or pain. Conclusion: The overall surgical outcomes were satisfactory without an osteotomy. Patients with a proximal duplication level or preoperative hypoplasia of the remaining toe should be informed of its possible small size postoperatively. Levels of Evidence: Level IV, retrospective case series.

PS02.137: SALVAGE ESOPHAGECTOMY AFTER DEFINITIVE CHEMORADIOTHERAPY: EXPERIENCES OF A SINGLE INSTITUTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 159-159
Author(s):  
Xufeng Guo ◽  
Zhigang Li
Keyword(s):  
Postoperative Complications ◽  
Perioperative Period ◽  
Clinical Staging ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Single Institution ◽  
Definitive Chemoradiotherapy ◽  
Term Survival ◽  
Nerve Paralysis ◽  
Salvage Esophagectomy

Abstract Background Definitive chemoradiotherapy (dCRT) is considered a standard treatment for locally advanced esophageal cancer. Despite of long-term survival of 15–20% after such treatment, locoregional recurrence occurs in around 40–60%. Further radiotherapy is often contraindicated because the maximal tolerable dose has been achieved. As for salvage chemotherapy, the treatment outcome is disappointing. Salvage surgery is another choice but its role still remains debatable. The present study was designed to evaluate the safety and efficacy of salvage esophagectomy. Methods 18 consecutive cases of salvage esophagectomy after dCRT by a single institution were analyzed. Results (1) 16 males and 2 females. There were 6 cases (33.3%) and 12 cases (66.7%) of recurrent and persistent tumor after dCRT respectively; (2) All the patients were treated with McKeown operation stytle combing thoracic and abdominal lymph nodes dissection. Esophagus was replaced by stomach of 15 cases and colon of 3 cases respectively. Radical resection (R0) was performed in 12 cases, palliative resection (R2) in 6 cases. There were 4 cases of pathological complete response (pCR); (3) The incidence of postoperative complications was 61.1% (11/18), including 6 cases of pulmonary infection, 4 cases of anastomotic leak, 2 cases of incision infection, one case of respiratory insufficiency, one case of recurrent laryngeal nerve paralysis, one case of chylothorax, one case of aortic bleeding caused by empyema; (4) One patient died in perioperative period because of aortic bleeding due to empyema. The follow-up period was from 2 to 26 months, and the median follow-up time was 9 months. There were 13 patients survived and 5 patients died at the last follow-up date including one death in perioperative period, 2 cases died of local-regional recurrence and metastasis respectively. Conclusion Salvage esophagectomy is a treatment option for the recurrent or persistent disease after dCRT, but the incidence of postoperative complications is high. Accurate clinical staging is especially important after dCRT and ycT4, ycN + patients should be avoided. R0 resection and recurrence after long disease free period are favorable prognostic factors. Disclosure All authors have declared no conflicts of interest.

Asymmetric superior oblique split Z-tendon lengthening for face turn in bilateral asymmetric superior oblique overaction and exotropia

2020 ◽  
pp. 112067211989798
Author(s):  
Massimiliano Serafino ◽  
Matteo Scaramuzzi ◽  
Claudia Specchia ◽  
Francesco Bonsignore ◽  
Paolo Nucci
Keyword(s):  
Oblique Muscle ◽  
Intermittent Exotropia ◽  
Left Turn ◽  
Vertical Deviation ◽  
Tendon Lengthening ◽  
The Face ◽  
The Right ◽  
Clinical Records ◽  
Superior Oblique Muscle ◽  
Superior Oblique

Introduction: The aim was to evaluate the effectiveness of the procedure of the superior oblique split Z-tendon lengthening to collapse A pattern and treat face turn in a cohort of patients with both incomitant intermittent exotropia and a vertical deviation associated with a bilateral asymmetric superior oblique overaction. Methods: We retrospectively reviewed the clinical records of patients with facial turn associated with intermittent exotropia and bilateral asymmetric superior oblique overaction, who underwent superior oblique muscle split tendon lengthening and concurrent horizontal surgery between 2009 and 2017. Results: A total of eight patients met the inclusion criteria. The preoperative average face turn was 26.8° (range, 20°–5°), and it significantly improved to 5.4° (range, 2°–8°) ( p < 0.05). All the patients showed an improvement in the face turn with neutralization of the vertical deviation. The vertical deviation in the right gaze for the patient with a right turn and the left gaze in patients with left turn improved significantly (values of p < 0.05). Conclusion: The superior oblique split Z-tendon lengthening was an effective procedure to collapse the A pattern and the treatment of the face turn in a cohort of patients with both incomitant intermittent exotropia and a vertical deviation associated with a bilateral asymmetric superior oblique muscle overaction with less complications, and less varying results.

Phacoemulsification on Previously Vitrectomized Eyes: Results of a 10-Year Period

2007 ◽  
Vol 17 (4) ◽  
pp. 601-604 ◽  
Author(s):  
Z. Szijártó ◽  
B. Haszonits ◽  
Z. Biró ◽  
B. Kovács
Keyword(s):  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Posterior Capsule Opacification ◽  
Posterior Capsule ◽  
Safe Procedure ◽  
Intraocular Pressure Elevation ◽  
Posterior Capsule Rupture ◽  
Pars Plana ◽  
Visual Results

Purpose To provide an overview of intraoperative and postoperative complications during phacoemulsification cataract surgery and to evaluate the visual results in patients having pars plana vitrectomy (PPV) with 10 years of follow-up. Methods Retrospective evaluation of intraoperative and postoperative complications and postoperative visual results in 134 consecutive patients who underwent phacoemulsification after PPV. Of 11,498 eyes treated with phacoemulsification, 143 (1.2%) had previous PPV during the 10-year period (January 1, 1995-December 31, 2004). A total of 134 eyes were included in this study. Results The phacoemulsification procedure seemed to be difficult where there was a deep or fluctuating anterior chamber (93%) and primary posterior capsule opacification (19%). The most frequent intraoperative complications were posterior capsule rupture (9%) and incomplete capsular rhexis (5%). Postoperative intraocular pressure elevation (7%), retinal detachment (6%), and posterior capsule opacification (8%) occurred most frequently during the mean follow-up period of 18.2 months (1.5–110 months). Best-corrected visual acuity (BCVA) increased two or more Snellen E lines in 55% of the cases or became better than or equal to 0.5 in 10% of the cases. Conclusions Despite the well-known difficulties encountered in vitrectomized eyes such as zonular damage, increased mobility of the lens-iris diaphragm, and altered intraocular fluid dynamics, phacoemulsification proved to be a safe procedure in the hands of experienced surgeons.

Sign in / Sign up

Export Citation Format

Share Document