Pre-dilation and Post-dilation in Transcatheter Aortic Valve Replacement: Indications, Benefits and Risks

Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with symptomatic severe aortic stenosis. In recent years, an emphasis has been placed on simplification of the procedure. Balloon predilation was initially considered a mandatory step to cross and prepare the stenotic aortic valve, but several studies demonstrated the feasibility of performing TAVR without balloon valvuloplasty. Balloon postdilation of the implanted valve is sometimes required to optimise results, although many patients do not require this step. Contemporary consensus advocates an individualised approach to TAVR procedures and so balloon pre- and post-dilation are performed selectively. This review aims to outline the advantages and disadvantages of balloon pre- and post-dilation and to identify the scenarios in which they are required during TAVR procedures.

Physical Therapy for the Horizontal Semicircular Cupulolithiasis: A Prospective Interventional Case Series from an Otoneurology Center in South Rajasthan, India

Objective This article aims to study the effect of physical therapy in patients of horizontal semicircular cupulolithiasis with results audited in the short term. Design Nonrandomized prospective interventional study. Study Sample Four patients with horizontal semicircular cupulolithiasis. Results All four patients in whom diagnostic supine roll test (carried at least thrice to look for the sustainability as well as the polarity of the nystagmus) elicited apogeotropic horizontal positional nystagmus lasting more than 1 minute were subjected to therapeutic head-shaking maneuver (HSM). The results were audited immediately after the physical therapy, and at 1 hour. Follow-up by telephonic interviews for 4 weeks was done in all patients. Three out of four patients responded to HSM alone. One patient who did not respond to HSM was successfully treated with four other sequent physical therapies. Conclusion The response of physical therapy for horizontal semicircular cupulolithiasis occasionally indicates the side of the cupula to which otoconial debris is adherent (Cup-U or Cup-C). Occasionally, Cup-C variant of horizontal semicircular cupulolithiasis can be transformed by physical therapy to long posterior arm horizontal semicircular canalolithiasis—a disorder with better established treatment options.

Effectiveness of Body Psychotherapy. A Systematic Review and Meta-Analysis

Despite the growing relevance and applicability of elements based on and derived from the embodied mind paradigm, body psychotherapy (BPT) appears not to be a well-established treatment option. This might be due to a lack of proof for its efficacy. We searched electronic databases (Pubmed MEDLINE, PsycInfo, and PSYNDEX) for randomized controlled trials (RCTs) examining predefined BPT interventions. A total of 2,180 references were screened, of which 113 studies were scrutinized in detail and 18 RCTs finally included. The observed effect size (ES) demonstrated medium effects of BPT on primary outcomes psychopathology and psychological distress. In case of significant statistical heterogeneity, exploratory subgroup analyses revealed diagnosis and the degree of control group activity as noteworthy moderators. For secondary outcomes, evidence was scarce, and an improvement could be demonstrated only for coping abilities. The identified evidence indicates that BPT is beneficial for a wide spectrum of psychic suffering. There is a strong need for high-quality studies with bigger samples and for well-defined diagnostic entities to underpin its effectiveness.

Ex vivo lung perfusion: how we do it

Lung transplantation is an established treatment for patients with end-stage lung disease. However, a shortage of donors, low lung utilization among potential donors, and waitlist mortality continue to be challenges. In the last decade, ex vivo lung perfusion (EVLP) has expanded the donor pool by allowing prolonged evaluation of marginal donor lungs and allowing reparative therapies for lungs, which are otherwise considered not transplantable. In this review, we describe in detail our experience with EVLP including our workflow, setup, operative technique, and protocols. Our multidisciplinary EVLP program functions with the collaboration of surgeons, pulmonologists, and EVLP nurses who run the pump. EVLP program has been a valuable addition to our program. Since Food and Drug Administration (FDA) approval in 2019, we experienced incremental increased lung transplant volume of 12% annually.

Successful Treatment of Incomplete Susac Syndrome with Simultaneous Corticosteroids and Plasmapheresis Followed by Rituximab

We present a case report of a patient with incomplete Susac syndrome. He had cognitive impairment, corpus callosum lesions, and vestibulocochlear dysfunction on brainstem auditory evoked responses. He was treated with methylprednisolone and plasmapheresis, improved, and then, also received rituximab. His improvement has been lasting as of this writing. This case shares our experience with a successful treatment of this rare condition that is incompletely understood and lacks well-established treatment guidelines.

Verfahrensintegrierende Verhaltenstherapie bei Angsterkrankungen -Lernen und Verlernen von pathologischer Angst als ganzheitlicher Prozess

Nicht zu Unrecht gilt die Behandlung von Angsterkrankungen als die Paradedisziplin der Verhaltenstherapie (VT). Hier wie auch generell zeigt sich die VT dabei aber als zersplittert in eine Vielzahl von Einzelmethoden: Verschiedene Lernformen – Einsichtslernen, Konditionierungslernen und Habituationslernen - werden in ihrem Beitrag zu Angsterkrankungen isoliert voneinander konzipiert. Entsprechend stehen auch auf diesen Lernformen basierende Therapiemethoden für sich. Dadurch werden wichtige Synergiepotenziale verschenkt. Menschliches Lernen, auch und gerade das Lernen und Verlernen von pathologischer Angst, ist aber immer ein ganzheitlicher Prozess. Der Artikel skizziert eine ganzheitliche Psycho-Logik der Eskalation und Chronifizierung pathologischer Angst unter integrierendem Einbezug der o.g. Lernformen. Hieraus leitet sich eine verfahrensintegrierende VT ab, die die etablierten Behandlungsmethoden so kombiniert, dass Synergiegewinne entstehen, was an einem Fallbeispiel verdeutlicht wird. Den theoretischen Hintergrund bildet die Theorie der Selbstorganisation komplexer Systeme, insbesondere die Synergetik – ein Feld, in dem wichtige Aspekte der Gestalttheorie aufgehoben sind. It is not without reason that the treatment of anxiety disorders is considered the showpiece of behavioral therapy (BT). Here as well as in general, however, the BT shows itself fragmented into a multitude of individual methods: Different forms of learning - insight learning, conditioning learning and habituation learning - are designed in isolation from each other in their contribution to anxiety disorders. Correspondingly, treatment methods based on these forms of learning stand for themselves. This gives away important synergy potential. Human learning, also and especially learning and unlearning of pathological anxiety, is always a holistic process. The paper outlines a holistic psycho-logic of the escalation and chronification of pathological anxiety, integrating the above mentioned forms of learning. This leads to the derivation of a method-integrating BT, which combines the established treatment methods in such a way that synergy gains are achieved, as illustrated by a case study. The theoretical background is formed by the theory of the self-organization of complex systems, in particular synergetics - a field in which important aspects of gestalt theory are implied.

Can Postoperative CT Imaging in Spine Surgery Be Replaced by Intraoperative 3D Rotation With the C-Arm?: Results of a Prospective Single Center Cohort Study

Objective: Dorsal instrumentation of the spine is an established treatment option for a range of spinal pathologies. Intraoperative fluoroscopy connected with navigation minimize the risk of incorrect screws placement. In several cases, post-operative CT scans are needed to verify possible mismatches. In this study, we evaluated the efficacy of 3D intraoperative fluoroscopy as compared to post-operative CT and the need of post-operative CT.Methods: We conducted a prospective single-center cohort study, 94 patients were included. The screws were implanted using 3D rotation with C-arm and navigation system. The definitive position of the screws was verified by a post-operative CT scan. Finally, we compared the discrepance between intraoperative imaging and post-operative CT scan using Rampersaud-grade (A-D).Results: 607 screws in 94 patients were included. Some 3% of the screws had to be replaced immediately intraoperative due to inadequate position with lateral or medial trajectory. An A-score was achieved for 85.5% of the 3D controlled screws and 87% of the post-operative CT. A B-score was found in 11.5% of either groups. In the 3D group a C-score was achieved for 2.5% and in the CT group for 0.8%. A D-score was found in 0.5% of the screws in both groups, p = 0.45. Only a mismatch of 3% could be detected for the intraoperative and post-operative imaging results.Conclusion: Our study data shows that the placement of screws using the 3D rotation and navigation tool is safe and accurate. There were no relevant mismatches between intraoperative images and the post-operative CT.

Organ donation in India and Nurses as a change to lead in Organ Donation: Scooping Review of Organ Donation

Organ donation is the donation of biological tissue or an organ of the human body from a living or dead person to a living recipient in need of a transplantation. Organ transplantation has made rapid strides over the last 6 decades and established its status from an experimental procedure to a well-established treatment modality. The great part of organ donation is most people can be organ donors. Nurses as being the largest part of any health care fleet can play a pivotal role in the dissemination of the right information, and nurse’s knowledge and commitment towards spreading awareness and motivating people pledging for organ donation are extremely important for the success of organ donation program.

Frequency of Bioprosthetic Valve Fracturing Utilization in an All-Comers Valve-in-Valve TAVR Cohort

Introduction: Valve-in-valve TAVR (ViV-TAVR) is an established treatment for failing surgical aortic valves in patient at high surgical risk. Elevated transprosthetic gradients are common after ViV-TAVR. Previously, bench tests showed feasibility of bioprosthetic valve fracturing (VF) using high-pressure balloons. Small case series show reduced transprosthetic gradients using VF. We present our clinical experience and outcome of VF.Material and Methods: Consecutive ViV-TAVR patients were identified from our institutional TAVR database and utilization of bioprosthetic valve fracturing or intraprocedural postdilatation was reviewed. Surgical valves were categorized as responsive or not responsive to VF. Transprosthetic gradients were compared in procedures with VF and procedures with or without postdilatation.Results: In 67 consecutive ViV-TAVR procedures between January 2018 and September 2020, VF was attempted in 15 cases with eight being successful. Standard postdilatation was performed in 21 patients and 31 cases were without postdilatation. Mean transprosthetic gradients (MPG) decreased from 34.2 + 12.5 to 12.7 + 7.4 mmHg (p < 0.001) for all patients. MPG was 8.6 + 3.5 mmHg after VF, 12.9 + 8.5 mmHg after standard postdilatation (p = 0.18) and 13.4 + 6.8 mmHg in cases without postdilatation (p = 0.04). In small surgical valves with true inner diameter <21 mm MPG was 9.1 + 3.5 mmHg after VF, 14.2 + 8.9 after standard postdilatation (p = 0.068) and 16.2 + 9.2 mmHg without postdilatation (p = 0.152). Failed attempts with BVF occurred with the Perimount standard valve.Conclusion: Bioprosthetic valve fracturing results in lower mean transprosthetic gradients after ViV-TAVR. Responsiveness of BVF in Perimount surgical valves, long-term hemodynamic outcome, and potential survival benefits need further evaluation.

Clear cell renal cancer metastasis in the contralateral ureter: a case report

Background Clear cell renal carcinoma is known for its propensity for metastatic spread. Common sites of metastasis are the lungs, bones, lymph nodes, liver, adrenals and brain, but all organs can be affected. Contralateral ureteral metastasis is a rare phenomenon, and only a few cases have been reported in the literature. Case presentation We present the case of a 58-year-old Caucasian patient with a single contralateral ureteral metastasis of a clear cell renal carcinoma. Conclusion Ureteral metastasis of clear cell renal carcinoma is very rare, and there is no well-established treatment. For patients with low metastatic spread/volume, the aim should be to preserve kidney function, and thus metastasectomy should be considered.