scholarly journals Endonasal dacryocystorhinostomy: evaluation of the anatomical and functional results

2020 ◽  
Vol 6 (3) ◽  
pp. 519
Author(s):  
Kanchan Tadke ◽  
Vaibhav Lahane ◽  
Akshay Sarode ◽  
Nitish .
Keyword(s):  
Functional Results ◽  
Strong Positive Correlation ◽  
Success Rates ◽  
Lacrimal Sac ◽  
Surgical Success ◽  
Variable Success ◽  
Endoscopic Dcr ◽  
Age Range ◽  
Anatomical Success

<p class="abstract"><strong>Background:</strong> Dacryocystorhinostomy is a novel surgical technique for NLD obstruction performed by external and endonasal approach. Both procedures have variable success rates and advantages or disadvantages. The objectives were to study functional and anatomic outcomes of endoscopic DCR and to assess degree of ostium shrinkage in postoperative period.</p><p class="abstract"><strong>Methods:</strong> Prospective study comprising 68 patients of NLD obstruction with 70 procedures performed during the period of October 2014 to October 2016. Various dimensions of bony neo-ostium were recorded intraoperatively and during 1st and 3rd month follow up. Mitomycin C was applied in 37 cases. Degree of ostium shrinkage and its correlation with surgical success was studied. Outcome of study was measured as functional and anatomical success.  </p><p class="abstract"><strong>Results:</strong> 68 patients in age range of 7 to 71 years. Mean intraoperative height and width were 12.0±2.08 mm and 5.17±0.82 mm respectively and intraoperative surface area of ostium was 62.77±17.27mm<sup>2</sup>. The study showed strong positive correlation between initial and final ostium size. The final ostium irrespective of its size, if patent does not result in recurrence of symptoms and can be considered as success. In the present study, functional and anatomical success was 97.14% and failure rate was 2.86%.</p><p><strong>Conclusions:</strong> Both functional and anatomical success require creation of patent neo-ostium, although the intraoperative size of ostium is not the deciding factor for final outcome. Complete exposure of lacrimal sac, adequate mucosal preservation, good marsupialization and mucosal apposition are the some of the crucial factors responsible for stable ostium patency and hence the surgical success.</p>

scholarly journals A New Modification in Endoscopic Endonasal Dacryocystorhi̇nostomy Scopy-Guided Approach

2021 ◽  
Author(s):  
Akalın İrfan ◽  
Ahmet Kalkışım ◽  
Hasan Gündoğdu
Keyword(s):  
Surgical Intervention ◽  
Nasolacrimal Duct ◽  
Silicone Tube ◽  
Endoscopic Endonasal ◽  
New Approach ◽  
Surgical Success ◽  
Endoscopic Dacryocystorhinostomy ◽  
Significant Difference ◽  
Endoscopic Dcr ◽  
Anatomical Success

Abstract PurposeTo compare and assess classic endoscopic dacryocystorhinostomy (cEDCR) and scopy-guided endoscopic dacryocystorhinostomy (sEDCR) which is a new approach we developed in cases of primary nasolacrimal duct obstruction (PNLDO).MethodsFifty eyes (7 in both eyes) of 43 patients who applied with epiphora and underwent endoscopic DCR and silicone tube implantation between 2015 and 2019 were prospectively studied. cEDCR was performed on 26 of 50 eyes, and sEDCR was performed on 24 of 50 eyes. In sEDCR application, 5 cc non-ionizing opaque material was injected after punctum dilatation, lateral oblique radiographs were taken from the obstructed side with C-arm scope, and the size and location of the lacrimal sac were made visible. Thence, the most appropriate part of the passage was visualized, and surgical intervention was made through this point. Patients were followed in day 1, week 1, 3rd and 6rd mounth. Functional success was assessed according to Munk scoring, and anatomic success was assessed with nasolacrimal lavage. Two groups were compared according to surgical success, time, and complications.ResultsMean age of the cases were 47.85 (±11.8) in the cEDCR group and 54.29 (±16.23) in the sEDCR group. Female and male gender distribution was 21 (80.8%) - 5 (19.2%) for cEDCR and 15 (62.5%) - 8 (37.5%) for sEDCR, respectively. Functional success was spotted as 92.3% in the cEDCR group and 95.8% in the sEDCR group (p:1.0); anatomical success was spotted as 88.5% in the cEDCR group, and 95.8% in the sEDCR group (p:0,611). There was no significant difference between two groups. Mean surgery time was 43 minutes in the cEDCR group and 48 minutes in the EDCR group. Complications were minor and rare (p >0.05). ConclusionAs we are aware of that, our study is the first in literature in which scopy is used in endoscopic DCR. In our study, the sEDCR approach is assessed as a useful modification which improves success and facilitates surgery.

DOZ047.91: Bronchoscopic treatment of recurrent tracheoesophageal fistula: is it an effective option?

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
N Valiyev ◽  
K K Cerit ◽  
M Y Erdas ◽  
A P Ergenekon ◽  
G Kiyan
Keyword(s):  
Success Rate ◽  
Tracheoesophageal Fistula ◽  
Late Complications ◽  
Laser Coagulation ◽  
Success Rates ◽  
Surgical Closure ◽  
Endoscopic Method ◽  
Effective Option ◽  
Age Range

Abstract Purpose Despite technical and surgical improvements, treatment of recurrent tracheoesophageal fistula (rTEF) still remains a challenging problem in pediatric patients. Bronchoscopic closure of rTEF using different agents is described with different success rates in the literature. This study aimed to report results of patients with rTEF treated with chemocauterization using trichloroacetic acid (TCA) and with laser cauterization (LC) followed by fibrin glue (FG) application. Methods Nine patients with rTEF were included in the study from 2014 to 2018. Four patients underwent fistula closure with LC followed by FG application, while another four patients had chemocauterization with TCA. In one case both agents were used. Patients were checked for the success of the treatment by bronchoscopy. All patients had the diagnosis of rTEF. Seven patients had EA with distal TEF and the remaining two patients had H-type TEF as primary pathologies. FG application was performed by LC followed by injection of FG into the fistula. Application of the TCA was made by a TCA-soaked sponge for 30 seconds and 3 times each trial. Results Nine children of the age range 4 months to 5 years (mean 1.5 year) were treated endoscopically. Follow-up ranged between 3 months and 5 years (mean 28 months). Among the nine patients only in one patient with only laser coagulation with FG application the treatment was successful. In the remaining eight patients all attempts failed. All these patients underwent open surgical closure of the fistula. There were no acute or late complications related to either endoscopic method. Conclusion The results of this study suggest that endoscopic occlusion of recurrent TEF has a low success rate. Surgical closure is still a standard method with a high success rate. Even though endoscopic options are less invasive, they prolong the period of aspiration and may cause increased pulmonary problems.

scholarly journals Vitrectomy with Air Endotamponade for Traumatic Cyclodialysis

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Anan Wang ◽  
Zhenquan Zhao
Keyword(s):  
Surgical Approach ◽  
Ultrasound Biomicroscopy ◽  
Success Rates ◽  
Corrected Visual Acuity ◽  
Pars Plana ◽  
The Difference ◽  
Anatomical Success ◽  
Anatomical Success Rate ◽  
Cyclodialysis Cleft

Background. Various techniques have been described for repairing cyclodialysis clefts, but there is no consensus regarding the optimal treatment. This study investigated the clinical efficacy of a novel surgical approach that is used to manage traumatic cyclodialysis. Methods. We prospectively enrolled 7 patients (7 eyes) with traumatic cyclodialysis of the concomitant lens and other vitreous diseases. Ultrasound biomicroscopy was used to diagnose cyclodialysis, and all eyes underwent pars plana vitrectomy with air endotamponade. The main outcome measures were postoperative anatomical success rates, best-corrected visual acuity (BCVA), and intraocular pressure (IOP). Results. All patients were male, and their age ranged from 46 to 64 years (mean: 54.3 years). After the surgical intervention, the extent of the cyclodialysis cleft ranged from 1 to 4 clock hours (mean: 2.3 clock hours) and the detached ciliary body of all cases was completely restored; the anatomical success rate was 100%. The BCVA significantly increased from 1.40 ± 0.49 to 0.42 ± 0.31 (P = 0.002). The IOP increased from 8.91 ± 1.77 to 14.67 ± 6.38, but the difference was not significant (P = 0.056). The postoperative IOP of most patients was temporarily elevated or lowered after surgery. At the last follow-up, there were still two abnormal cases, including one with ocular hypertension and one with hypotony. Conclusions. This study revealed that vitrectomy with air endotamponade is an effective and minimally invasive alternative surgical approach for small traumatic cyclodialysis clefts.

scholarly journals Anatomical and Functional Evaluation of Conventional vs Inferior Endoscopic Dacryocystorhinostomy in Study Cases of Idiopathic Chronic Dacryocystitis

2017 ◽  
Vol 10 (2) ◽  
pp. 86-90
Author(s):  
Aditya Kashyap ◽  
Satisg Negi ◽  
Prem L Chauhan ◽  
Kuldeep Thakur
Keyword(s):  
Operative Time ◽  
Nasal Endoscopy ◽  
Functional Evaluation ◽  
Lacrimal Sac ◽  
Endoscopic Dacryocystorhinostomy ◽  
Group I ◽  
Chronic Dacryocystitis ◽  
Endoscopic Dcr ◽  
Fluorescein Dye

ABSTRACT Objective To compare the results of conventional nasal endoscopic dacryocystorhinostomy (DCR) and inferior nasal endoscopic DCR in Study cases of idiopathic chronic dacryocystitis. Materials and methods Forty patients diagnosed with idiopathic chronic dacryocystitis were divided into two groups alternately. After relevant investigations, they were subjected for endoscopic DCR by two techniques. Twenty patients underwent conventional endoscopic DCR and 20 underwent inferior endoscopic DCR under transoral pterygopalatine block and topical lignocaine (4%) with adrenaline 1:2,000. After 3 months of follow-up in the outpatient department, nasal endoscopy along with fluorescein dye disappearance test (FDDT) at 10 minutes was done. Results Ninety-five percent (19/20) of patients undergoing conventional endoscopic DCR and 90% (18/20) of patients undergoing inferior endoscopic DCR were found to have patent anatomical fistula. On FDDT, nasal endoscopy after 10 minutes revealed 84% (16/19) in group I and 94.4% (17/18) in group II with fluorescein in nasal cavity. Conclusion Present study concludes the importance of bony, tendinous, and muscular support of lacrimal sac in physiological lacrimal pump functioning and advantage of relatively new technique of inferior endoscopic DCR. Inferior endoscopic DCR is associated with less operative time as well as less local complications. How to cite this article Thakur K, Kashyap A, Negi S, Chauhan PL. Anatomical and Functional Evaluation of Conventional vs Inferior Endoscopic Dacryocystorhinostomy in Study Cases of Idiopathic Chronic Dacryocystitis. Clin Rhinol An Int J 2017;10(2):86-90.

scholarly journals Coverage of defects over toes with distally based local flaps: A report of four cases

2008 ◽  
Vol 41 (01) ◽  
pp. 62-66
Author(s):  
Ashok Raj Koul ◽  
Rahul K. Patil ◽  
Vinoth Kumar Philip
Keyword(s):  
Donor Site ◽  
Advancement Flap ◽  
Skin Flaps ◽  
Challenging Problem ◽  
Success Rates ◽  
Muscle Flaps ◽  
Variable Success ◽  
Distally Based ◽  
Extensor Digitorum Brevis

ABSTRACTreconstruction of the distal foot, especially of the toe has always been a challenging problem. various methods have been tried with variable success rates and limitations. presented here is a series of four cases, where distally based flaps were used. two of them were extensor digitorum brevis (edb) muscle flaps and the other two were first dorsal metatarsal artery (fdma) based skin flaps. one in each of the two was augmented with a plantar v-y advancement flap. all flaps survived completely without any flap- or donor site-related complications. the patients were ambulated two weeks following the reconstruction and were symptom-free after an average follow-up of thirteen months. distal flaps based on the dorsalis pedis system provide a reliable cover for distal foot defects.

Surgery of the Lacrimal System

2011 ◽  
Author(s):  
Roger A. Dailey ◽  
Mauricio R. Chavez
Keyword(s):  
Prospective Study ◽  
Success Rate ◽  
Nasolacrimal Duct ◽  
The Other ◽  
Success Rates ◽  
Lacrimal Sac ◽  
Other Hand ◽  
A Prospective Study ◽  
External Dcr

Obstruction of the tear outflow system can occur anywhere along its course from the tear lake to the inferior meatus of the nose. Surgical techniques designed to relieve this functional or complete obstruction have been available for a long time. Toti of Italy described the dacryocystorhinostomy (DCR) procedure in 1908 as a treatment modality for obstruction of the nasolacrimal duct. His technique did not make use of mucosal flaps. Dupuy-Dutemps of France, on the other hand, encouraged the use of flaps. He recommended suturing together the nasal mucosal and lacrimal sac flaps. The success rate of the operation improved dramatically. Today the external DCR procedure makes use of modifications of both of these historically described procedures. In recent years, intranasal DCR has enjoyed renewed popularity. This procedure had been performed by Lester Jones and others for years but was dropped because the success rate was 80% at best. Although the use of endoscopic techniques and laser technology has been advocated by some authorities, the success rate (approximately 70%) with relatively short-term follow-up has limited its acceptance. More recently, Javate and associates reported a series of patients undergoing endoscopic DCR with the radiofrequency Ellman unit. Their reported success rate of 90% compared favorably with a 94% success rate in 50 age-matched patients undergoing external DCR with a follow-up of 9 months. This rate also compares favorably to the present authors’ success rate of approximately 95% in uncomplicated cases undergoing external DCR and a similar rate with the endoscopic approach without use of a laser. Therefore, the laser does not appear to offer any significant advantage over more traditional intranasal approaches, and the cost may actually be a financial disincentive to its use. The benefit of mitomycin continues to be debated. You and associates performed a prospective study showing favorable long-term success rates with the use of mitomycin. On the other hand, Liu and associates performed a prospective study that demonstrated no benefit. While the DCR works well for lacrimal sac or nasolacrimal duct obstruction, it does not address obstructions of the puncta and canaliculi.

scholarly journals Pulsed Vincristine Therapy in Steroid-Resistant Nephrotic Syndrome

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Shenal Thalgahagoda ◽  
Shamali Abeyagunawardena ◽  
Heshan Jayaweera ◽  
Umeshi Ishanthika Karunadasa ◽  
Asiri Samantha Abeyagunawardena
Keyword(s):  
Nephrotic Syndrome ◽  
Side Effects ◽  
Sustained Remission ◽  
Success Rates ◽  
Steroid Resistant ◽  
Steroid Resistant Nephrotic Syndrome ◽  
Paediatric Nephrologist ◽  
Variable Success ◽  
Steroid Regimen ◽  
Age Range

Steroid-resistant nephrotic syndrome (SRNS) poses a therapeutic challenge for the paediatric nephrologist. As relentless progression to renal failure occurs with continued proteinuria, such patients will be treated with different cytotoxic medications with variable success rates and side-effects. We present here our findings on administering the anticancer drug vincristine for SRNS patients at a single centre in Sri Lanka. Methods. Between 2002 and 2007, fifty-four children presenting with steroid and cyclophosphamide resistance were treated with vincristine at 1.5 mg/m2 in weekly intravenous pulses for 8 weeks along with a tapering steroid regimen of 6 months. All patients were closely followed up for 5 years. Results. Of the 54 patients 39 were males and 15 were females (age range 3.5–11.6 years, median 6.1 years). At the end of the treatment course, 21 patients achieved complete remission while 7 had partial remission and no response was seen in 26 patients. Sustained remission at 6, 12, 24, and 60 months were 15 (27.78%), 11 (20.37%), 9 (16.67%), and 7 (12.96%), respectively. Most side-effects observed were reversible and no serious side-effects were noted during vincristine therapy. Conclusion. Although its therapeutic mechanisms in nephrotic syndrome are still not elucidated, vincristine appears to be a potent alternative that could be considered for treating SRNS.

scholarly journals Specific features of endoscopic dacryocystorhinostomy – case report

2015 ◽  
Vol 5 (17) ◽  
pp. 45-51
Author(s):  
Lucian Lapusneanu ◽  
Alina Neacsu ◽  
Andreea Naca
Keyword(s):  
Nasolacrimal Duct ◽  
Stent Insertion ◽  
Lacrimal Sac ◽  
Endoscopic Dacryocystorhinostomy ◽  
Evaluation Protocol ◽  
Chronic Dacryocystitis ◽  
History Of ◽  
Ophthalmologic Examination ◽  
Endoscopic Dcr ◽  
Age Range

AbstractOBJECTIVE. The aim of the study was to evaluate the endoscopic dacryocystorhinostomy (DCR) with some particularities and its advantages over external DCR. MATERIAL AND METHODS. We evaluated 3 female patients (age range 35-84 years) diagnosed with chronic dacryocystitis - lacrimal sac abscess (2 cases) and lacrimal sac fistula (1 case). All patients presented a history of repeated episodes of acute dacryocystitis initially treated with broad spectrum antibiotics by the ophthalmologist. The evaluation protocol consisted in cranio-facial CT scan or MRI for the evaluation of the lacrimal sac and nasal structures, an ophthalmologic examination with the catheterization of the superior and inferior lacrimal punctum with a light probe to verify the permeability of the lacrimal pathway, and the Jones test with fluorescein to receive information about the common lacrimal path. Lacrimal syringing with regurgitation of fluid from the opposite punctum was the only criteria to decide the surgery. In all three cases we performed an endoscopic DCR, with stent insertion in two cases and a laco-dacryo-rhinostomy in one case. In only one case a reintervention was needed 12 months later. CONCLUSION. The endoscopic DCR, with its different particularities, is a safe surgical procedure with a low rate of complications, being the treatment of choice for the treatment of nasolacrimal duct obstruction.

scholarly journals A New Modification in Endoscopic Endonasal Dacryocystorhi̇nostomy: Scopy-Guided Approach

2021 ◽  
Author(s):  
Akalın İrfan ◽  
Ahmet Kalkışım ◽  
Hasan Gündoğdu
Keyword(s):  
Surgical Intervention ◽  
Nasolacrimal Duct ◽  
Silicone Tube ◽  
Endoscopic Endonasal ◽  
New Approach ◽  
Surgical Success ◽  
Endoscopic Dacryocystorhinostomy ◽  
Significant Difference ◽  
Endoscopic Dcr ◽  
Anatomical Success

Abstract PurposeTo compare and assess classic endoscopic dacryocystorhinostomy (cEDCR) and scopy-guided endoscopic dacryocystorhinostomy (sEDCR) which is a new approach we developed in cases of primary nasolacrimal duct obstruction (PNLDO).MethodsFifty eyes (7 in both eyes) of 43 patients who applied with epiphora and underwent endoscopic DCR and silicone tube implantation between 2015 and 2019 were prospectively studied. cEDCR was performed on 26 of 50 eyes, and sEDCR was performed on 24 of 50 eyes. In sEDCR application, 5 cc non-ionizing opaque material was injected after punctum dilatation, lateral oblique radiographs were taken from the obstructed side with C-arm scope, and the size and location of the lacrimal sac were made visible. Thence, the most appropriate part of the passage was visualized, and surgical intervention was made through this point. Patients were followed in day 1, week 1, 3rd and 6rd mounth. Functional success was assessed according to Munk scoring, and anatomic success was assessed with nasolacrimal lavage. Two groups were compared according to surgical success, time, and complications.ResultsMean age of the cases were 47.85 (±11.8) in the cEDCR group and 54.29 (±16.23) in the sEDCR group. Female and male gender distribution was 21 (80.8%) - 5 (19.2%) for cEDCR and 15 (62.5%) - 8 (37.5%) for sEDCR, respectively. Functional success was spotted as 92.3% in the cEDCR group and 95.8% in the sEDCR group (p:1.0); anatomical success was spotted as 88.5% in the cEDCR group, and 95.8% in the sEDCR group (p:0,611). There was no significant difference between two groups. Mean surgery time was 43 minutes in the cEDCR group and 48 minutes in the EDCR group. Complications were minor and rare (p >0.05). ConclusionAs we are aware of that, our study is the first in literature in which scopy is used in endoscopic DCR. In our study, the sEDCR approach is assessed as a useful modification which improves success and facilitates surgery.

Laser Transcanalicular Endonasal DCR

2010 ◽  
Vol 3 (1) ◽  
pp. 23-25 ◽  
Author(s):  
Pravesh Yadav ◽  
Ravi Meher ◽  
Kavita Goyal ◽  
Virad Kumar ◽  
Aditi Chopra
Keyword(s):  
Success Rate ◽  
Failure Rate ◽  
Nasolacrimal Duct ◽  
Success Rates ◽  
Duct Obstruction ◽  
Endonasal Dcr ◽  
Endoscopic Dcr ◽  
External Dacryocystorhinostomy ◽  
Preliminary Study

Abstract Nasolacrimal duct obstruction is a common disorder which clinically manifests as epiphora. Many procedures have been described to bypass this obstruction, for example external dacryocystorhinostomy (DCR), endoscopic DCR with and without stents, Laser endoscopic DCR. Each of these procedures has its own success rates and complications. We did an analysis of all laser assisted endonasal DCR performed in our department from Feb 2006 to July 2009. In all we had operated 237 total cases out of which 203 were with normal endonasal DCR and 34 cases were Laser transcanalicular endonasal DCR (Laser DCR). Over all success rate was 92%(218 cases). In case of Laser assisted endonasal DCR the success rate was 70.3% (19 cases) with failure rate of 29.7% (8 cases) at three months follow-up. This preliminary study reveals that LASER DCR is associated with higher failure rates as compared to the normal endonasal DCR.

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