Augmentation uretero-enterocystoplasty for lower urinary tract dysfunction: a long-term retrospective efficacy study / 中华泌尿外科杂志

Objective:To investigate the long-term efficacy and complications of augmentation uretero-enterocystoplasty (AUEC).Methods:The clinical data of 262 patients with lower urinary tract dysfunction who underwent AUEC at our center from January 2003 to June 2022 were analyzed retrospectively. There were 193 males and 69 females, the median age was 24 (4, 67) years, the median disease duration was 12.0 (0.2, 56.0) years and the preoperative creatinine was 91.5 (68.1, 140.0) μmol/L. 320 ureters had high-grade UUTD, 216 ureters had VUR, 14 of which had low-pressure reflux.The number of low-grade VUR ureter was 22 (10.2%) and the number of high-grade VUR ureter was 194 (89.8%). Video-urodynamics showed that the maximum bladder capacity was 102 (47, 209) ml, the maximum detrusor pressure was 33.0 (15.5, 50.5) cmH 2O, and the bladder compliance was 6.4 (3.0, 12.3) ml/cmH 2O. All patients underwent AUEC. The surgical method is to cut a segment of sigmoid colon, open the sigmoid colon along the mesenteric margin, fold and suture it into " U" or " S" shaped intestinal mesh according to the principle of " detubulization" . At the same time, perform ureteroplasty and replanting, and then anastomosis the intestinal mesh with the opened bladder flap to form an expanded new bladder. Follow-up was performed via outpatient clinic or telephone. The creatinine, maximum bladder capacity, maximum detrusor pressure, bladder compliance, ureteral reflux and upper urinary tract dilatation were compared preoperatively and postoperatively. The postoperative complications were also evaluated. Results:The median follow-up time was 57.4 (4, 151) months after surgery. At 1-3 months after surgery, the maximum bladder capacity and bladder compliance increased to 303.9% and 189.9% of the preoperative level, and the maximum detrusor pressure decreased to 63.6% of the preoperative level. At 6-10 years after surgery, the maximum bladder capacity and bladder compliance increased to 490.2% and 627.9% and the maximum detrusor pressure decreased to 25.8% of the preoperative level. The UUTD of the patients was significantly reduced after surgery. The number of the high grade UUTD decreased to 116 (116/398, 29.2%) at 1-3 months and 51 (51/274, 18.6%) at 4-6 months. At 6-10 years, the number of the high-grade UUTD decreased to 4 (4/76, 5.3%) ( P<0.001), which was significantly lower than that before operation. The VUR was significantly relieved after operation, and 393 ureters had no VUR at 1-3 months, accounting for 97.8% (393/402) of the total ureters. Sustained remission of VUR was observed during follow-up. 73 ureters had no VUR at 6-10 years, accounting for 96.1% (73/76) of total ureters ( P<0.001). Patients' creatinine decreased to 79.0 (65.0-128.2) μmol/L at 1-3 months postoperatively, with a downward trend but no statistical difference, and creatinine levels were not significantly elevated at any postoperative time point compared with preoperative levels ( P>0.05). Postoperative complications included metabolic acidosis in 26 cases (9.9%), vesicoureteral anastomosis stenosis in 15 cases (5.7%), recurrent urinary tract infection in 16 cases (6.1%), and urinary calculi in 20 cases (7.6%), and intestinal obstruction requiring laparotomy in 8 cases (3.1%), all of them could be improved after treatments. Conclusions:AUEC is a safe and effective method for treating high-grade VUR or VUR with impaired anti-reflux mechanism, high-grade UUTD or UUTD with ureteral or vesicoureteral junction obstruction, and all of the complications can be improved after treatment. This technique can increase the bladder capacity and compliance, reconstruct the anti-reflux mechanism, and release upper urinary tract obstruction. It may play an important role in stabilizing and protecting the residual renal function from further deterioration.

Surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery / 中国胸心血管外科临床杂志

@#Objective     To review the experience of the surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery (ALCAPA). Methods     A retrospective, single institution review was conducted on thirty-six adult patients with ALCAPA surgical treatment from November 1991 to November 2017 in Fuwai Hospital. Of these patients, nine were males and twenty-seven were females. The mean age was 36.6±13.3 years. The mean weight was 60.0±9.4 kg. The preoperative echocardiography showed the mean left ventricular ejection fraction (LVEF) was 57%±6% and the mean left ventricular end-diastolic dimension (LVEDD) was 52.3±6.3 mm. Severe mitral regurgitation (MR) was seen in one patient, moderate in five patients. The operative procedures included coronary artery re-implantation in seventeen patients, Takeuchi operation in sixteen patients, ligation of left coronary artery plus coronary artery bypass graft in three patients. In addition, six patients underwent mitral valve repair. Results     There was no in-hospital mortality. The mean cardiopulmonary bypass time was 152.5±72.9 min and aortic cross clamp time was 101.9±43.6 min, respectively. The mean mechanical ventilation time and ICU time was 17.3±16.3 h and 43.1±30.7 h, respectively. The mean postoperative LVEF was 59%±6%, which did not significantly improve compared with preoperative LVEF. However, the mean postoperative LVEDD of 46.9±5.9 mm had significant reduction compared with the preoperative LVEDD. Of the six patients with mitral valve repair, one was mild and the other five were trivial. Thirty-five patients (97.2%) completed the follow-up with a mean time of 5.5 years. All the patients survived with New York Heart Association class Ⅰor Ⅱ. Two patients needed interventional occlusion or re-operation due to the fistula of internal tunnel within the pulmonary artery. At the latest echocardiography, the mean LVEF of 69%±7% improved significantly compared with the preoperative LVEF. Mild MR was detected in ten patients, moderate in two patients during the follow-up period. Conclusion     The surgical treatment of adult patients with ALCAPA has satisfactory short- and long-term results. The patients who underwent Takeuchi procedure may need re-operation due to fistula of internal tunnel within the pulmonary artery during the long-term follow-up.

Improvement of the Ischemic Area after Surgical Treatment for Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery / 日本心臓血管外科学会雑誌

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly. Although asymptomatic in most cases, with the anomaly only being detected incidentally, surgical correction should be considered before onset of severe myocardial ischemia in such cases. Here, we present a 70-year-old man who was referred to our department due to chest pain on effort and was given a diagnosis of ARCAPA concomitant with mild aortic stenosis. As the symptoms and the degree of aortic stenosis deteriorated during follow-up, the patient underwent direct re-implantation of the right coronary artery into the ascending aorta and aortic valve replacement. The patient's postoperative course was uneventful, and the symptoms disappeared. Postoperative myocardial perfusion scintigraphy revealed improvement of the myocardial ischemic area.

Performance and clinical comparison between left ventricular quadripolar and bipolar leads in cardiac resynchronization therapy: Observational research

Aim To evaluate Attain Performa (Medtronic, Dublin, Ireland) quadripolar lead performance in clinical practice and, secondarily, to compare its long term clinical outcomes vs bipolar leads for left ventricular (LV) pacing. Methods and results We retrospectively analyzed clinical, procedural and follow-up data of 215 patients implanted with a quadripolar lead. One hundred and twenty one patients implanted with bipolar lead were selected to compare long-term clinical outcomes. The quadripolar lead was implanted in the target vein in 196 patients (91%) without acute dislodgements. In 50% of patients the chosen final pacing configuration at implant would not have been available with bipolar leads. A dedicated quadripolar pacing vector was chosen more frequently when the LV tip location was apical than otherwise (65.6% vs 42.7%, p = 0.003). After a median follow-up of 14 months, the LV pacing threshold was less than 2.5 V at 0.4 ms in 98 patients (90%) with a safety margin between phrenic nerve and LV pacing threshold >3 V in 97 patients (89%). We observed a slight trend toward a lower risk of heart failure worsening and a lower incidence of ventricular arrhythmias and pulmonary congestion in patients implanted with quadripolar leads compared with the control group. Conclusion Quadripolar leads improve the management of phrenic nerve stimulation at no trade-off with pacing threshold and lead stability. Quadripolar leads seems to be associated with a lower incidence of VT/VF and pulmonary congestion, when compared with bipolar leads, but further investigations are necessary to confirm that this positive effect is associated with better LV reverse remodeling.

Intentional Re-implantation-a Viable Treatment Option

Intentional re-implantation is a procedure in which a tooth is intentionally extracted and then reinserted into its own socket for various treatment modalities. In this case report, we discuss a case of intentional re-implantation as a treatment option for failed root canal treatment with broken instrument in the apical 1/3rd of a maxillary first molar. A follow up for 2 year revealed the patient to be asymptomatic, the tooth to be sound and functional with no evidence of root resorption.

Reimplantación, anquilosis y sustitución con implante. Presentación de caso clínico / Re-implantation, ankylosis and replacement with implant. Clinical case presentation

La reimplantación es la colocación en el alvéolo de un diente totalmente luxado (accidental o intencionalmente); es citada como una forma de trasplante dental; este tratamiento puede funcionar adecuadamente y en algunos casos se presenta anquilosis, definiendo este proceso como la fusión del diente y el hueso alveolar. Objetivo: Presentar un diente reimplantado, con tratamiento endodóntico, anquilosado, con reabsorción radicular y su sustitución con un implante dental. Presentación del caso: Paciente femenino de 32 años, remitido al Departamento de Periodoncia e Implantología por resorción ósea del OD 12. Como antecedentes dentales referidos por el paciente, el diente fue extraído y reimplantado intencionalmente después del tratamiento endodóntico. Después de trece años, la corona se fracturó y en el examen radiográfico se apreció resorción radicular externa y anquilosis. El tratamiento consistió en regeneración ósea guiada post-extracción y a los seis meses la inserción de un implante 3i® de 3.25 × 15 mm, con provisional inmediato, el margen gingival fue modificado por medio de gingivoplastia e incremento en el contorno del provisional. Para mejorar la estética y morfología de la encía queratinizada se realizó una cirugía plástica mucogingival con instrumentos rotatorios. Resultados: Después de un año se concluyó la rehabilitación que consistió en una corona atornillada de porcelana.

Re-implantation is a procedure whereby an accidentally or intentionally fully luxated tooth is placed in a socket. It is considered a form of tooth transplant. This treatment can adequately function, in certain cases, ankylosis might be present. This process can be defined as fusion of tooth and alveolar bone. Objective: Presentation of a re-implanted, ankylosed endodontically treated tooth with root resorption and replacement of this tooth with dental implant. Case presentation: A 32 year old female patient was referred to Periodontics and Implantology Department due to bone resorption of tooth number 12. Dental history reported by patient informed that tooth was extracted and intentionally re-implanted after endodontic treatment. After thirteen years the crown fractured, radiographic examination revealed external root resorption and ankylosis. Treatment consisted on guided bone regeneration after extraction and placement of 3i® implant (3.5 × 15 mm) with immediate load, the gingival margin was modified by means of gingivoplasty procedure and increase of provisional's crown contour. In order to improve esthetics and morphology of keratinized gingiva, muco-gingival plastic surgery was conducted with rotary instruments. Results: One year later, rehabilitation was completed with a screwed-in, fixed porcelain crown.

Surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery / 中华胸心血管外科杂志

Objective To review the experience of the surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery(ALCAPA).Methods A retrospective,single institution review was conducted on nineteen adult patients with ALCAPA surgical treatment from February 2006 to October 2012.Of these patients,five were males and fourteen were females.The age was(35.3 ± 11.7) years.The weight was (61.2 ± 9.4) kg.Most patients showed some evidence of myocardial infarction or ischemia with either abnormal Q waves (4) or ST-T abnormality (13).Twelve patients with coronary angiography and four patients with coronary CT scan showed good coronary collateralization.The preoperative UCG showed the mean left ventricular ejection fraction(LVEF) was 0.60 ± 0.07,and the mean left ventricular end-diastolic dimension(LVEDD) was(52.4 ± 4.4) mm.Severe mitral regurgitation(MR) was seen in two patients,moderate in three patients and mild in four patients.The operative procedures included Takeuchi operation in seven patients,ligation of left coronary artery concomitant with coronary artery bypass graft in two patients,coronary artery re-implantation in ten patients.Of the ten patients with coronary artery re-implantation,two patients underwent mitral valve repair.Results There was no operative mortality.The mean cardiopulmonary bypass time was (144.5 ± 66.9) min and cross-clamp time was (96.4 ± 38.8) min,respectively.The mean mechanical ventilation time was(12.9 ± 3.7) h and intensive care unit time was(39.2 ± 12.5) h,respectively.The mean postoperative LVEF was 0.62 ± 0.04.No significant reduction in LVEDD (45.8 ± 5.5) mm,P ＞ 0.05.Mild and trivial MR were observed in one and four patients,respectively.Sixteen patients(84.2％) completed the follow up with a mean time of 19.2 months.All the patients survived with New York Heart Association class Ⅰ or Ⅱ.During the follow up period,no patient required reoperation or readmission.At the latest echocardiography,the mean LVEF of 0.63 ± 0.05 and mean LVEDD of(49.2 ± 4.6) mm did not significantly improved compared with the data preoperatively or postoperatively.Mild MR was detected in six patients,trivial in three patients during the follow-up period.Conclusion The adult patients with ALCAPA have a dormant disease process.Surgical treatment has been recommended at the time of diagnosis and the coronary re-implantation could be the first choice.As for the concomitant MR,the guideline for the adult MR should be followed.

Treatment of 21 pediatric patients with pulmonary artery sling combined with tracheal stenosis / 中国小儿急救医学

Objective Total 21 pulmonary artery sling( PA sling)combined with tracheal stenosis children who received treatment in our hospital were reviewed. The feasibility of treatment strategy including left pulmonary artery( LPA)re-implantation without tracheoplasty was discussed in this study. Methods From April 2009 to November 2015,a total of 21 pediatric patients received surgical treatment due to PA sling with tracheal stenosis. Six patients received LPA re-implantation and trachea intervention simultaneously. The other 15 patients received LPA re-implantation alone to relieve the trachea compression without tracheoplasty. The postoperative strategy including early extubation and CPAP ventilation was employed in PICU. Results A total of 21 PA sling with tracheal stenosis children who underwent surgical treatment in our hospital were recruited. There were 9 females and 12 males. Ages of these children were from 1 months to 10 years old,and body weights were from 2. 9 kg to 25. 0 kg. Five patients needed mechanical ventilation for severe respiratory symptoms preoperatively. Six patients received LPA re-implantation and tracheal interven-tion simultaneously. Among them,3 patients received slide tracheoplasty,and one was discharged after recov-ery. The remaining 3 patients received tracheal stent implantation,but finally died. The survival rate was 16. 7% in these patients. Fifteen patients received LPA re-implantation alone,and slide tracheoplasty was per-formed in 2 patients for extubation failure who finally died of air leakage. The survival rate of 15 patients who received LPA re-implantation alone was 86. 7%. Conclusion The strategy in LPA re-implantation alone to relieve the trachea compression without tracheoplasty and early extubation and CPAP ventilation postoperative may be an ideal treatment for the pediatric patients with PLA sling combined with tracheal stenosis.

Reimplante dentario después de 72 horas avulsionado / Dental re-implantation 72 hours after avulsion

La reimplantación dentaria ha sido uno de los procedimientos más exigente de rigor y precisión en cuanto a las condiciones que deben existir para lograr el éxito esperado. El propósito de esta presentaciòn es mostrar la evolución y tratamiento del auto-implante del incisivo lateral superior izquierdo, 72 horas después de avulsionado. Se trata de paciente masculino de 18 años de edad, con antecedentes de salud. Acude a consulta luego de tres días de avulsionado el incisivo lateral superior izquierdo por trauma. Se le explicó al paciente el posible fracaso del tratamiento por el tiempo transcurrido, puesto que la inmediatez con que sea tratado favorece el éxito. Se le realizó el reimplante dentario y ferulizó. Se realizó el tratamiento endodóntico al diente en dos sesiones de una semana entre ellas. Se realizaron evoluciones trimestrales y luego semestrales. Casi cinco años después, la evidencia radiográfica no muestra complicaciones existentes y clínicamente presenta una apariencia normal. Los resultados obtenidos fueron satisfactorios y después de cinco años el paciente se mantiene con su diente en boca completamente asintomático(AU)

The dental re-implantation is one of the procedures demanding most rigor and precision in terms of the conditions required to achieve the expected success. Our purpose is to present the evolution and treatment of a case of auto-implantation of the upper left lateral incisor 72 hours after avulsion. The patient was a male 18 year-old with a history of ill health presents three days after avulsion of the upper left lateral incisor as a result of trauma. The patient was informed of the possible failure of the treatment due to the time elapsed. In cases such as this one, immediate treatment is essential to achieve success. Dental re-implantation and ferulization were performed. The tooth was treated endodontically on two visits one week apart. Checkups were conducted which were quarterly at first and then biannual. Almost five years later, radiographic evidence shows no complications and clinical appearance is normal. The results were satisfactory. The patient has preserved his tooth for five years and his status is totally asymptomatic(AU)

Analysis of early dental implant failure and retreatment of 6 cases / 实用口腔医学杂志

Objective:To analyse the causes of early implantation failure and the therapeutic measures with re-implantation after the failures.Methods:6 cases of implantation failure including early infections,loosening and non-osteointegration were reviewed and trea-ted by re-implantation therapy,and the causes of failure were discussed and the effects of re-treatment were evaluated.Results:2 cases were found to be with infection of adjacent teeth after implantation and were treated by removal of the implant,socket curettage,root ca-nal therapy(RCT)and antibiotics followed by reimplantation.Implant loosening and non-osteointegration were observed in 4 cases, which were treated by the similar methods for the implant socket.Reimplantation was successful in all 6 cases followed-up for 1 -3 years.Conclusion:Preventive measure for implantation failure should include indication selection,control of infections in adjacent teeth and periodontosis,use of GBR technic and so on.Re-implantation following proper treatment of adjacent teeth and the socket of implant is effective for the treatment of implantation failure.

Re-implantation of a degloving amputation of distal index finger caused by fireworks: a case report and literature review / Re-implantación de una amputación por desguantamiento de un dedo índice distal causada por fuegos artificiales: Reporte de caso y revisión de la literatura

Amputations associated with fireworks are customarily treated by stump revision resulting in permanent disability. In this case report, we present an eight-year old boy who suffered an amputation of his right distal index finger at the level of the epiphyseal disk with degloving injury of the amputated finger caused by fireworks. Successful re-implantation was achieved. Two-year follow-up revealed fair cosmesis and acceptable functional and aesthetic recovery though the free distal phalanx had been absorbed completely. Re-implantation of a degloving amputation finger caused by fireworks is possible and can provide good distal soft tissue coverage and recovery ofsensory and motor functions.

Las amputaciones relacionadas con fuegos artificiales son tratadas habitualmente por revisión de muñón, lo que trae como resultado una discapacidad permanente. En este reporte de caso, presentamos a un niño de 8 años que sufrió una amputación de su dedo índice derecho distal a nivel del disco epifisario con lesión por desguantamiento del dedo amputado causada por fuegos artificiales. Se logró una re-implantación exitosa. Los dos años de seguimiento revelaron una corrección quirúrgica cosmética satisfactoria, así como una recuperación funcional y estética aceptable, aunque la falange distal libre había sido absorbida completamente. La re-implantación de un dedo amputado por desguantamiento causado por fuegos artificiales es posible y puede proporcionar buena cobertura de tejido suave distal y recuperación de las funciones sensoriales y motoras.

Dealing with dental implant failures

An implant-supported restoration offers a predictable treatment for tooth replacement. Reported success rates for dental implants are high. Nevertheless, failures that mandate immediate implant removal do occur. The consequences of implant removal jeopardize the clinician’s efforts to accomplish satisfactory function and esthetics. For the patient, this usually involves further cost and additional procedures. The aim of this paper is to describe different methods and treatment modalities to deal with dental implant failure. The main topics for discussion include identifying the failing implant, implants replacing failed implants at the exact site, and the use of other restorative options. When an implant fails, a tailor made treatment plan should be provided to each patient according to all relevant variables. Patients should be informed regarding all possible treatment modalities following implant failure and give their consent to the most appropriate treatment option for them.

Comparison of Articular Spacer Versus Static Spacer in the Treatment of Infected Total Knee Arthroplasty

PURPOSE: To compare and analyze the surgical procedure and clinical results of two-stage re-implantation using both articulating and static spacers at infected total knee arthroplasties(TKA). MATERIALS & METHODS: A total of 14 cases were selected for subject of this study in which patients had been diagnosed as infected TKA and had undergone two-stage re-implantation(7 using static spacers and remaining 7 using articulating spacers) from March 1999 to March 2006. RESULTS: In the group using static spacers, ROM improved from 70 degrees in average preoperatively to 98 degrees postoperatively. In the group using articulating spacers, ROM improved from 74 degrees to 105 degrees (p=0.532). HSS score showed an increase from 43 scores in average preoperatively to 81 postoperatively for static spacers and from 41 to 83 for articulating spacers(p=0.780). There was no significant difference in the hour spent for the 1st surgery. The 2nd operation time was shortened to 241 minutes in case of static spacers, and 208 minutes in articulating spacers. One case of relapse was reported with static spacers but none with articulating spacers. CONCLUSION: Two-stage re-implantation of infected TKA using both static and articulating spacers has been found to be effective ways of treatment, requiring, however, long term follow-ups.