Current Issue : January - March Volume : 2019 Issue Number : 1 Articles : 5 Articles
Objective: Cataract is a partial or total opacification of the lens responsible\nfor blindness. The treatment is surgical. The purpose of our study was to evaluate\nthe results of the newly introduced manual small incision cataract surgery\n(SICS) and compare them with those of the conventional extra-capsular\nextraction method. Patients and Method: Analytical cross-sectional study\nwas carried out at the ophthalmology department of the University Hospital\nof Bouaké for a period of 1 year. Results: The two surgical techniques were\ncompared at equal proportions. The average duration of interventions was\nlonger during the sutured Extra Capsular Extraction (ECE) compared to the\nSICS. Rupture of the posterior capsule with vitreous exit, which was the most\nobserved intraoperative complication, was predominant with ECE with suture\n(16%) against 8% for SICS. Corneal edema observed in the early postoperative\nperiod, was predominant with sutured ECE (30%), against 20% for SICS.\nCorneal edema, which was more observed with EEC compared to SICS, dominated\nsecondary and late postoperative complications. Post-operative astig matism\ninduced by ECE with suture was between .................... of patients and between .... dioptre in 73.91% of SICS. Visual acuity\nwithout correction in the early days was better with SICS. Conclusion: In this\ncomparative study of cataract surgery, we noted superimposable results for\nboth techniques. However, the prevalence of pre- and post-operative complications was more frequent with sutured ECE. The technique without suture\nallows visual recovery and a quick return to normal life....
Objectives: To compare the long term outcomes between minimally invasive\nmitral valve repair (MiMVR) and conventional surgery. Current retrospective\ncomparisons between the techniques frequently report echocardiographical\n(echo) outcomes early after surgery and rarely report them later. Methods:\nPatients were selected for MiMVR by the surgical multi-disciplinary meeting\nfrom June 2008-March 2013. Patients included had at least two transthoracic\npost-operative echocardiograms. Echocardiographic parameters including left\nventricular size and systolic function, degree of mitral regurgitation (MR) and\nmean mitral valve gradient were recorded. Clinical outcomes including\nall-cause mortality, re-operation, recurrence of at least moderate MR and\nelevated mean mitral valve gradients > 5 mmHg were recorded and compared\nusing Kaplan-Meier survival analysis. Results: 223 patients were screened, 96\n(43%) met the criteria and were included. Thirty-seven patients underwent\nconventional surgery and 59 underwent MiMVR. Mean clinical follow-up\nwas 6.3 years and echo follow up was 3.2 years. There was a significantly\nhigher recurrence of moderate MR in the conventional group (38% (n = 19)\nversus 17% (n = 10)). The mean LV end-diastolic diameter was 4.8 cm (conventional)\nversus 5.0 cm (MiMVR). The incidence of elevated PG was 26% (n\n= 13, conventional) and 23% (n = 14, MiMVR). There was no significant difference\nin incidence in re-operation (conventional 12% (n = 6), MiMVR 8.3% (n =\n5)). Long-term mortality was higher in the conventional group (1.7% vs. 18%\np = 0.004) although the logistic Euroscore was significantly higher 6.8% ± 5.4\nvs. 3.6% ± 1.6. Conclusions: Minimally invasive mitral valve surgery is safe\nand feasible in selected patients with good medium and long-term echocar diographic follow-up....
Background and Purpose. Debate exists on whether septic revision total knee arthroplasty (TKA) results in inferior clinical\noutcomes, and limited information is available regarding the factors associatedwith such outcomes.This study aimed to (1) compare\nclinical outcomes and characteristics of aseptic versus septic revision TKA and (2) identify the risk factors associated with inferior\nclinical outcomes. Methods.We retrospectively reviewed 144 revision TKAs (90 aseptic and 54 septic revisions) that were followed\nfor a minimumof 3 years (mean = 7 years). Clinical outcome data, namely, Knee Society knee and function scores and the Hospital\nfor Special Surgery knee score, were collected. We reviewed 13 pre- and intraoperative variables. Results. Postoperative clinical\noutcomes were inferior in septic revision surgeries (p<0.05). In regression analyses, however, septic revisionwas not an independent\nrisk factor for poor clinical outcomes. The independent risk factors for poor outcome were identified where Anderson Orthopedic\nResearch Institute grade 3 femoral and tibial bone defects, more than three surgeries, and treatment for persistent infection were\nassociatedwith inferior clinical outcomes (all p<0.05). Standard two-stage septic revisionwithout grade 3 bone defects or additional\nsurgeries showed comparable outcomes to aseptic revision. Interpretation. Clinical outcomes of septic revision were inferior to those\nof aseptic revision. However, poor outcomes were mainly associated with large bone defects and an increased number of surgeries.\nThe outcomes of aseptic and septic revision surgery were similar when patients with larger bone defects and more than three\nsurgeries were excluded....
Chemoradiotherapy has emerged as a gold standard in advanced squamous cell carcinoma\nof the head and neck (SCCHN). Because 50% of advanced stage patients relapse after nonsurgical\nprimary treatment, the role of salvage surgery (SS) is critical because surgery is generally regarded as\nthe best treatment option in patients with recurrent resectable SCCHN. Surgeons are increasingly\nconfronted with considering operation among patients with significant effects of failed non-surgical\nprimary treatment. Wide local excision to achieve clear margins must be balanced with the morbidity\nof the procedure, the functional consequences of organ mutilation, and the likelihood of success.\nAccurate selection of patients suitable for surgery is a major issue. It is essential to establish objective\ncriteria based on functional and oncologic outcomes to select the best candidates for SS. The authors\npropose first to understand preoperative prognostic factors influencing survival. Predictive modeling\nbased on preoperative information is now available to better select patients having a good chance to\nbe successfully treated with surgery. Patients with a high comorbidity index, advanced oropharyngeal or hypopharyngeal primary tumors, and both local and regional recurrence have a very limited\nlikelihood of success with salvage surgery and should be strongly considered for other treatments.\nFollowing SS, identifying patients with postoperative prognostic factors predicting high risk of\nrecurrence is essential because those patients could benefit of adjuvant treatment or be included in\nclinical trials. Finally, defining HPV tumor status is needed in future studies including recurrent\noropharyngeal SCC patients....
Introduction: The inflammatory response is essential to initiate the healing\nprocess, and in this response there is an increase in white blood cells and\npro-inflammatory compounds. C reactive proteins (CRP), together with the\nblood leukocyte count, have been used to study the immune response. Due to\nthe risk of infection and exacerbated inflammatory response of the patients\nundergoing surgical procedure, it is relevant to investigate the pre and postoperative\ninflammatory response of those individuals. Objective: To determine\nthe difference in the impact of elective cholecystectomy surgery on the\npatientâ??s immune response. Methods: The present study was cross-sectional,\nwhere a group included patients who underwent elective cholecystectomy\nprocedure. Patients who were pregnant, under 18 years, of indigenous communities\nor with other conditions that depress the immune system, as well as\nthose on immunosuppressive medications, were excluded. Results: CRP and\nleukocyte counts indicated a mean increase of 5.97-fold (95% CI 3.76 to 8.34,\nSD 6.98) and 1.97-fold (95% CI 1.71 to 2.24, SD 1.97) respectively, both being\nevaluated before and after surgery. Discussion: In the present study, to avoid\na possible methodological bias, it was chosen to evaluate the patients submitted\nto video laparoscopic cholecystectomy only and the hypothesis was confirmed\nthat there is an increase in CRP and leukocyte count as a response to\nsurgical trauma. Conclusion: There was an elevation of the inflammatory\nmarkers in patients submitted to surgical trauma when comparing the exams\ncollected in the preoperative period and after the surgical aggression....
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