Tracheal stomaplasty in tracheoesophageal punctured alaryngeal patients: is it a must?

The purpose of this study is to highlight the stenotic effect of tracheoesophageal puncture and the implanted voice prosthesis on the tracheostoma of alaryngeal patients and to evaluate the role of primary tracheostomaplasty in prevention of this stenosis. This was a prospective clinical study conducted in the Otolaryngology Department of Tanta University Egypt. The records of seventy-seven laryngectomized patients who were operated on between January 2000 and February 2006 were reviewed and divided into two major groups; those with tracheoesophageal puncture [puncture-study group] and those without [control group]. The two groups were then subdivided between those with stomaplasty [subdivision A] and those without [subdivision B]. The rates of tracheostoma stenosis in the two major groups and in the four subdivisions were compared and statistically analyzed considering different risk factors. In the puncture group, the total incidence of tracheostoma stenosis was 18 in 45 cases [40%] including 3 in 24 cases in subdivision-A [12.5%] and 15 in 21 cases in subdivision-B [71%], while its total incidence in the control group was 6 in 32 cases [19%] including 1 in 17 cases in subdivision A [9%] and 5 in 15 cases in subdivision B [33%]. On analysis, the risk factors within both the major groups were almost similar. Performing primary tracheostomaplasty after completion of total laryngectomy dramatically reduces the stenotic effect of this puncture and other risk factors

Problems with tracheoesophageal puncture for a laryngeal voice rehabilitation: how to manage?

The tracheoesophageal puncture [TEP] technique and the application of its associated voice prostheses may give rise to adverse events. We present our experience with this technique with special attention to the incidence and management of these adverse events. Retrospective clinical analysis. 75 laryngectomized patients underwent TEP for voice restoration; they were included into two groups; Group 1, 43 patients with secondary TEP and Group II, 32 patients with primary TEP. Charts were reviewed regarding the incidence, management, and outcome of the adverse events encountered during their follow-up. Problems arose in the study patients, were itemized as either early or late problems. The same patient may develop one or more problems in either group. Management of the problems concerned the creation and maintenance of the TEP and the prostheses are presented. By an intensive and consequent multidisciplinary approach to problems, most of the inevitable adverse events can be solved adequately, minimizing the discomfort for the patient who has undergone laryngectomy and uses indwelling voice prosthesis

Treatment of trochanteric fractures by external fixator in patients with high unacceptable operative risk

External fixation has been used for the management of fractures since a long period of time. Good fixation, mild blood loss and early ambulation are always the main advantages for this technique. Other advantages include: it is simple, quick, inexpensive and causes minimal surgical trauma. The goal of this study was to report and evaluate the place of external fixation in the treatment of trochanteric fractures in patients with high unacceptable operative risk to withstand conventional osteosynthesis and to obviate the many disadvantages of traction and prolonged rest in bed. From January 1998 to December 2000, 22 patients, 6 males and 16 female, mean age 65.03 years, suffering from trochanteric fracture and considered preoperatively as "poor medical status"; were treated by external fixation and early mobilization. Technique was prescribed. All fractures except one were united at approximately 12.2 weeks [range 11.4-12.85 weeks]. Soft tissue interposition led to non-union in one patient. Deep screws-track infection was found in one case. Two cases had DVT. The use of the external fixator in these patients reduced their time in the hospital and facilitated their postoperative rehabilitation by allowing uncomplicated healing of a complicated fracture

Spinal cord decompression and stabilization for secondries of the thoracic and lumbar spine

A retrospective assessment of the decompression-stabilization procedures for malignant spinal lesions was done. Twenty-six patients underwent decompression-stabilization procedures for metastatic spinal lesions. The patients were classified according to their malignant lesion involvement of the three columns of the spine. One column was involved in only one case, two columns were involved in eleven cases and three columns were involved in fourteen cases. A posterior approach alone was done in eight patients, while combined anterior- posterior approach was done in eighteen cases. A variety of posterior stabilization procedures was used. The results obtained from direct anterior approaches using vertebrectomy and anterior reconstruction of the anterior and middle columns produced the best results in terms of neurological improvement. Almost all of the patients had two or three columns involvement, but the results did not support the three columns theory, where the significant results regarding the pre- or postoperative radiographic measurements [mechanical instability] and pre- or postoperative neurologic findings [neurologic instability] could not be correlated with the number of the involved columns

Lumbar pedicle screw fixation to improve correction of idiopathic scoliosis

Twenty-three consecutive patients with King-Moe type-I [thoracolumbar and lumbar] adolescent idiopathic scoliosis were treated with posterior spinal instrumentation using lumbar pedicle screw constructs. From the plain radiographs, the Cobb angles of the major curves and their correction were noted. Apical vertebral rotational angle and its correction were estimated from a single CT scan through the apical vertebra of the curve. A balance was also assessed on the posteroanterior [PA] radiographs by measuring a deviation from the median sacral line off C7. The average time of follow up examination was 28.8 months after surgery [range, 19-34 months]. The study concluded that using lumbar pedicle screw constructs for King-Moe type-I curve, idiopathic scoliosis was effectively derotating the scoliotic curve with no evidence of decompensation or imbalance within the coronal plane. Segmental pedicle screw fixation is a safe and effective method for correcting the triplanar deformity of the idiopathic thoracolumbar and lumbar scoliosis

Lumbar interlaminar microdiscectomy

The primary rationale lor surgery for disc prolapse is to relieve nerve root irritation or compression due to herniaied disc material. From 1997 to 1999; a total of 47 patients had microdiscectomy through an interlaminar approach for lumbar disc herniation, 27 men and 20 women, had a mean age of 42 years. The procedure was performed under surgical microscope. Clinical outcome and patient satisfaction were assessed at an average follow-up of 12.5 months. The results showed 83% excellent, 13% good, 2% fair, and 2% poor outcome. Microsurgical discectomy has significant shorter operative time [p =0.001] and significant reduction in back and leg pain [p =0.0001]. There were also a significant improvement of function, spinal range of motion, tension signs and sensation [p=0,0001], Although the rate of satisfactory outcomes was approximately the same in both microscopic discectomy and the standard procedure mentioned in previous literatures, microdiscectomy had a shorter duration of postoperative disability and used medications. The use of the microscope can facilitate the operation and give a better visual comfort. Moreover, the surgeon must be familiar with this technique and must have received training in its use

Bullet migration in the spinal subarachnoid space causing radicular symptoms

Bullet migration has been rarely reported. In this case report, we describe a 49-year-old woman who sustained a gun shot injury to the abdomen. After splenectomy for ruptured spleen, she developed weakness of the left lower limb [grade 3] and Babinski sign. Preoperative X-ray and CT scan of the spine showed the bullet at the level of S[1-2]. However, after laminectomy, the bullet was not in place and interoperative X-ray showed it in a new position at L[4-5]. The wound had to be extended and ultimately the bullet was removed. In patients with intraspinal bullets, preoperative fluoroscopy should be performed prior to surgical exploration