Surgical Outcomes of Modified Medial Rectus Resections in Recurrent Intermittent Exotropia

PURPOSE: To evaluate the outcomes of modified medial rectus (MR) resection using a lowered amount of MR resection for recurrent exotropia after bilateral lateral rectus (LR) recessions. METHODS: Fifty-six patients, who underwent MR resection from 2003 to 2017 for recurrent exotropia after bilateral LR recessions, were included. MR resection was performed using modified MR resection with a smaller amount of resection than the standard of 4 mm resection at 20 prism diopters (PD) of exotropia. Postoperative surgical results at 1 month, 6 months, 1 year and 2 years were classified as a success (5 PD esotropia [ET]-10 PD exotropia [XT]), overcorrection (>5 PD ET), and undercorrection (>10 PD XT). The clinical factors affecting surgical results at postoperative 6 month and 2 years were also evaluated. RESULTS: The success rate was 78.2% at postoperative 1 month and 87.5% at postoperative 6 months. The overcorrection rate was 21.8% and the undercorrection rate was 0% at postoperative 1 month. At postoperative 6 months, the overcorrection rate decreased to 0% and the undercorrection rate was 12.5%. The success rate was 85.7% at postoperative 1 year and 66.6% at postoperative 2 years. There was no clinical factor affecting the surgical outcomes except the ocular alignment at postoperative 1 month. The deviation at postoperative 1 month was more esotropic in patients with success at postoperative 6 months and 2 years than that in patients with undercorrection (p < 0.05). CONCLUSIONS: The modified MR resection showed favorable results of 87.5% at postoperative 6 months and 85.7% at 1 year. The angle of deviation at postoperative 1 month was an indicator of subsequent surgical outcomes.

Retrospective analysis of 79 patients with orbital floor fracture: outcomes and patient-reported satisfaction

BACKGROUND: The aim of our retrospective study is to evaluate the management of isolated orbital floor fractures considering the clinical, functional and aesthetic results according to the surgical approach and the type of materials used. METHODS: Retrospectively, clinical, radiological, surgical, and ophthalmological data from 79 patients were collected from January 2010 to December 2016. Furthermore, included patients were interrogated on functional and aesthetic satisfaction. RESULTS: The main causes of trauma were physical aggression followed by accidents. The median time between trauma and surgery was 4 days. The most common surgical approaches were the subciliary and the transconjunctival ones. Alloplastic materials were used in 75 patients. In two patients, we used a combination of two grafts. Patients experienced minor immediate complications. On follow-ups, none of our patients suffered from ocular movement restrictions. Patients treated by subciliary approach had higher risk of retractile scaring compared to other surgical approaches. In our study, patients agreed to complete a questionnaire assessing functional and aesthetic outcomes with a high satisfaction score. No association between the implant material used and the results has been assessed. CONCLUSION: This study describes the results of orbital floor reconstructions. Despite a variety of materials used and surgical approaches performed, we believe that the transconjunctival approach is the most suitable option with a high satisfaction score.

Reparación artroscópica con banda simple en pacientes con lesión aislada de ligamento cruzado posterior. Serie de Casos / Single-row arthroscopic repair in patients with isolated posterior cruciate ligament injury. Case Series

Introducción La lesión aislada del ligamento cruzado posterior ocasiona inestabilidad y falla del componente rotatorio de la rodilla. El objetivo del trabajo es describir los resultados del tratamiento artroscópico con banda simple operados por técnica de un solo haz con monotúnel y fijación con tornillos interferenciales en pacientes con lesiones aisladas del Ligamento Cruzado Posterior grado III. Materiales & métodos Estudio transversal. Se utilizó el formulario IKDC para evaluar tratamiento de lesiones del Ligamento Cruzado Posterior preoperatoriamente y al año. La estadística empleada fue descriptiva, se utilizaron medidas de tendencia central y dispersión, U de Mann Whitnney-Wilcoxon para comparar medias. Resultados Fueron 5 pacientes, 4(80%) fueron masculinos y 1(20%) femenino, la edad promedio 27.8 años (mínima 20, máxima 33) ± 5.58 años, el lado afectado fue derecho en 3(60%), izquierdo en 2(40%) pacientes, todos presentaron signo de cajón posterior positivo. Los resultados del formulario IKDC prequirúrgico y al año fueron: diferencia de promedios 2.6, suma de rangos negativos 15, suma de rangos positivos 0, z= -2.070, p=0.038, al año ningún paciente presentó signo de cajón posterior positivo. Discusión El tratamiento de lesiones aisladas del LCP grado III con técnica de un solo haz y monotúnel con autoinjerto de isquiotibiales por vía artroscópica ofrece resultados buenos.

Background Isolated lesions of the posterior cruciate ligament cause instability and failure in the rotating component of the knee. The objective of this article is to describe the results of single-row arthroscopic treatment using a single-bundle technique with a single tunnel and fixation with interference screws in patients with isolated lesions of the Posterior Cruciate Ligament, grade III. Methods A cross-sectional study was conducted using the IKDC Test to evaluate, pre-operatively and yearly, the treatment of posterior cruciate ligament injuries. The statistics used were descriptive, as well as measures of central tendency and dispersion, and Mann Whitney U- Wilcoxon tests to compare means. Results The study included 5 patients, 4 (80%) were male and 1 (20%) female, and a mean age 27.8 years (minimum 20, maximum 33) ± 5.58 years). The affected side was right in 3%, left in 2 (40%) patients, and all showed a posterior drawer sign. The results of the pre-operative IKDC test were: difference of means 2.6, sum of negative ranks 15, sum of positive ranks 0, z = -2.070, P=.038; after surgery no patient had a positive posterior drawer sign. Discussion The treatment of isolated grade III lesions of PCL with a single bundle and tunnel technique with an arthroscopic autograft of hamstrings offers good results.

The impacts of the left ventricular size for infants with total anomalous pulmonary venous connection on the early results of anatomical correction / 中华胸心血管外科杂志

Objective To investigate the impacts of the left ventricular size for infants with total anomalous pulmonary venous connection(TAPVC) on the early results of anatomical correction.Methods From Jan 2010 to Jun 2013,103 cases of TAPVC children under 1 year of age received biventricular correction in our hospital,including 65 males and 38 females with the mean body weight of(5.3 ± 1.3) kg.Taking left ventricular end-diastolic volume index(LVEDVI) of 20 ml/m2 as a boundary,all the children were divided into two groups:Small LV group and the Near normal LVgroup.Various factors including age,body weight,pathological type,pulmonary venous obstruction and restricted atrial septal defect were compared between the two groups.The Z value were introduced to demonstrate the small extent of the left atrium and left ventricle of TAPVC patients in comparison with the normal children.TAPVC correction surgery were performed with conventional median sternotomy,moderate hypothermic cardiopulmonary bypass and combined malformations were treated simultaneously.Results 45 patients were classified to Small LV group and 58 patients were classified toNear normal LV group.71.1％ of all Small LV patients was diagnosed as the obstruction type of TAPVC,the ratio was significantly higher than that of theNear normal LV group.The Z value of left ventricular end-diastolic diameter in theSmall LV group was significantly lower than that of the Near normal LV group.The mean CPB and aortic clamping time of all patients were (96.6 ± 34.4) min and (58.0 ±21.1) min respectively.There were 4 early postoperative death and the overall mortality was 3.9％.No patient was dead of low cardiac output.The duration of postoperative mechanical ventilation,ICU stay and vasoactive drugs application in Small LV group was significantly longer than that of Near normal LV group.Conclusion TheSmall LV,which should be viewed as relative dysplasia of left ventricle ,is more common in obstructive type of TAPVC.As long as the sizes of mitral valve and aortic valve were not significantly reduced,anatomic correction can be implemented and need not to concern the reducing degree of left ventricle.Nevertheless,the prevention and treatment of low cardiac output in the operation and early postoperative period were still key points for small LV patients to achieve good surgical results.

Research on the relationship between the various factors of traumatic brain injury patients before surgery and intraoperative surgical results / 中国现代医生

Objective To investigate the relationship between the various factors of traumatic brain injury patients un-dergoing surgery before the results of surgery. Methods A retrospective analysis from June 2011 to December 2014 in our hospital's clinical data line occupancy brain decompression surgery, 92 cases of traumatic brain injury patients,including a good number of surgical outcomes of 56 patients,the number of 36 patients with a poor prognosis cases. By Pearson univariate and multivariate Logistic regression analysis determine factors affecting the surgical results in pa-tients with traumatic brain injury. Results(1)By Pearson univariate analysis,good prognosis group and a poor progno-sis group in age, GCS score, systolic blood pressure, SpO2 respect, the differences were statistically significant (P<0.05);(2) the analysis of the single-factor results to substitute Logistic regression model, ultimately affecting the sur-gical results obtained in patients undergoing brain injury factors age(β=0.419,SE=0.192,Wald=8.293,P<0.05, OR=1.827,95%CI for 1.362~2.209), GCS score (β=0.753,SE=0.368,Wald=9.091,P<0.05,OR=2.238,95% CI of 1.827~3.114), systolic blood pressure(β=0.746,SE=0.273,Wald=7.082,P<0.05,OR=2.372,95%CI of 1.402~4.156),SpO2(β=0.810,SE=0.556,Wald=10.281,P<0.05,OR=2.591,95%CI of 2.211~3.391). Conclusion The factors affecting the brain injury surgical results are mainly age, GCS score, systolic blood pressure and SpO2 levels, preoperative should observe carefully these factors to improve prognosis in patients with traumatic brain injury situation.

Malformaciones arteriovenosas. Revisión y análisis estadístico de 52 MAVs tratadas durante el período de 2000-2010. Tercera parte / Arteriovenous malformations. Review and statistical analysis of 52 MAVs treated during the period 2000-2010. Third part

INTRODUCCIÓN: describir nuestra experiencia en el tratamiento de las MAVs analizando: procedimientos endovasculares utilizados, resultados postoperatorios y complicaciones asociadas, estadificación según escalas de Barthel y Rankin modificadas. MATERIAL Y MÉTODOS: la población de estudio se constituyó por 52 pacientes con MAVs la cual fue analizada y estudiada mediante examen neurológico pre y postoperatorio, TC cerebral, RM cerebral y arteriografía de 4 vasos de cuello, la totalidad fue tratada mediante cirugía convencional en nuestro Servicio durante el período comprendido entre los años 2000 a 2010. RESULTADOS: recibieron tratamiento endovascular previo a la cirugía 16 MAVs (30,76 %). Todas fueron operadas. Doce pacientes mejoraron en el postoperatorio (23,07 %), 30 pacientes (57,69%) no sufrieron modificaciones y 10 de ellos (19,23%) empeoraron durante el postoperatorio. La mortalidad fue de 7 casos (13,46 %). CONCLUSIÓN: consideramos a los procedimientos endovasculares y la radiocirugía una herramienta de indudable valor terapéutico. Creemos que el subgrupo de MAVs grados III, IV y V representa una entidad singular que las distingue del resto, como una subtipo que requiere más aun de una compleja toma de decisiones. Tuvimos las mayores complicaciones postoperatorias en MAVs grados III y IV. Nuestra mortalidad postoperatoria coincide con la bibliografía consultada

INTRODUCTION: to describe our experience in treating AVMs based on the endovascular procedures used, postoperative results and associated complications, staging according to Barthel Index and modified Rankin Scale. PATIENTS AND METHOD: we present 52 patients with AVMs which were analysed and studied by Pre and Post-Surgery Neurological exam, brain CT, Brain IRM and four Neck vessels arteriography. All the patients were treated by conventional Surgery at our Department of Neurosurgery for the 2000­2010 period. RESULTS: Sixteen patients with AVMs (30.76%) underwent endovascular treatment prior to surgery. 100% were operated. 12 patients (23.07%) improved their clinical condition in the postoperative period, 30 patients (57.69%) showed no changes, and 10 of them (19.23%) experienced deterioration during the postoperative period. There were 7 mortal cases (13.46%). CONCLUSION: we believe that endovascular procedures and radiosurgery are tools of immense therapeutic value. We also consider that the subgroup of AVMs grade III, IV and V have unique features that distinguish them among the rest as a subtype, thus requiring extreme care when making decisions. Most postoperative complications occurred with AVMs grade III and IV. The mortal cases in the postoperative period coincided with those mentioned in the bibliography consulted

Results of Open Surgical Repair of Chronic Juxtarenal Aortic Occlusion

PURPOSE: The aim of study was to review the results of open surgical repair (OSR) of chronic juxtarenal aortic occlusion (JRAO). MATERIALS AND METHODS: We retrospectively reviewed the results of OSR performed in 47 patients (male, 92%; mean age, 59.9+/-9.3 years [range, 44-79]) with chronic JRAO during the past 21 years. In order to reduce intraoperative renal ischemic time (RIT), we excised a portion of the occluded segment of the infrarenal aorta without proximal aortic clamping. We then performed suprarenal aortic clamping with both renal arteries clamped, removed the proximal aortic thrombus cap, confirmed both renal artery orifices, and moved the suprarenal aortic clamp to the infrarenal aorta to allow renal perfusion and standard aortoiliac reconstruction. We investigated early (<30 days) postoperative surgical morbidity (particularly renal function), operative mortality, and longterm patient survival. We conducted risk factor analysis for postoperative renal insufficiency. RESULTS: The mean intraoperative RIT was 10.7+/-5.5 minutes (range, 3-25), including 6 patients who underwent concomitant pararenal aortic thromboendarterectomy. Postoperatively, five (11%) patients had transient renal insufficiency, one had pneumonia, and one patient had an acute myocardial infarction. However, there was no operative mortality or newly developed dialysis-dependent renal failure. Postoperative follow up was available in 36 (77%) patients for a mean period of 6.3 years (range, 1 month-17 years). Kaplan Meier calculations of patient survival at 5 and 10 years after surgery were 91.2% and 83.6%, respectively. CONCLUSION: We have experienced short RIT, acceptable early postoperative results and long-term survival after OSR of chronic JRAO.

Thirteen-year Experience of 44 Patients with Adult Hemorrhagic Moyamoya Disease from a Single Institution: Clinical Analysis by Management Modality

Our objective was a retrospective assessment of the management modalities that provided the most beneficial treatment in hemorrhagic moyamoya disease during the last 13 years at our institution. The clinical results of 44 patients with hemorrhagic moyamoya disease were investigated, comparing revascularization surgery (direct, indirect, and combined bypass) or conservative treatment. Angiographic features, rebleeding, and clinical outcome were investigated. Six of the 35 patients (17.1%) with revascularization surgery experienced rebleeding, as did 4 of 9 patients (44.4%) with conservative treatment. However, patients who underwent bypass surgery had a lower chance of rebleeding. No significant difference in chance of rebleeding was observed between bypass surgery and non surgery groups (p > 0.05). Cerebral angiography performed after bypass surgery showed that for achieving good postoperative revascularization, direct and combined bypass methods were much more effective (p < 0.05). While the risk of rebleeding in the revascularization group was generally lower than in the conservative treatment group, there was no statistically significant difference between treatment modalities and conservative treatment. Although statistical significance was not attained, direct and combined bypass may reduce the risk of hemorrhage more effectively than indirect bypass.

Thirteen-year Experience of 44 Patients with Adult Hemorrhagic Moyamoya Disease from a Single Institution: Clinical Analysis by Management Modality

Our objective was a retrospective assessment of the management modalities that provided the most beneficial treatment in hemorrhagic moyamoya disease during the last 13 years at our institution. The clinical results of 44 patients with hemorrhagic moyamoya disease were investigated, comparing revascularization surgery (direct, indirect, and combined bypass) or conservative treatment. Angiographic features, rebleeding, and clinical outcome were investigated. Six of the 35 patients (17.1%) with revascularization surgery experienced rebleeding, as did 4 of 9 patients (44.4%) with conservative treatment. However, patients who underwent bypass surgery had a lower chance of rebleeding. No significant difference in chance of rebleeding was observed between bypass surgery and non surgery groups (p > 0.05). Cerebral angiography performed after bypass surgery showed that for achieving good postoperative revascularization, direct and combined bypass methods were much more effective (p < 0.05). While the risk of rebleeding in the revascularization group was generally lower than in the conservative treatment group, there was no statistically significant difference between treatment modalities and conservative treatment. Although statistical significance was not attained, direct and combined bypass may reduce the risk of hemorrhage more effectively than indirect bypass.

Coccygodynia and Coccygectomy

OBJECTIVE: A review of the literature on coccygectomy and our patients was performed to assess the effectiveness of coccygectomy for chronic refractory coccygodynia. METHODS: An English language PubMed search was conducted with the terms "coccygodynia" and "coccygectomy" from January 1980 to January 2012. We retrospectively reviewed the medical records and performed telephone questionnaire on 61 patients who underwent coccygectomy at UCDMC between 1997 and 2009. RESULTS: There were 28 case series from 1980 to 2012 for a total of 742 patients who underwent coccygectomy following failed conservative management. The mean age ranged from 26.4 to 52.8 years. The most common cause was direct trauma (58.5%) with a male:female ratio of 1:5.2. Most patients (84%) had a good to excellent outcome after coccygectomy. The most common complication is wound infection (10.0%). The overall complication rate was 13.3%. Similarly, 84.6% of patients from our own surgical case series reported good to excellent outcomes with 11.5% wound infection. CONCLUSION: Coccygectomy is an effective treatment for chronic refractory coccygodynia. The surgery isrelatively simple to perform but precaution must be taken to avoid wound infection.