ABSTRACT
A precise pre-procedural evaluation of mitral valve (MV) pathology is essential for planning the surgical strategy for severe mitral regurgitation (MR) and preparing for the intraoperative procedure. In the present case, a 38-year-old woman was scheduled to undergo MV replacement due to severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy. A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet. However, the "en face" view of the MV in the left atrial perspective using intraoperative real time three-dimensional transesophageal echocardiography (RT 3D-TEE) provided a different diagnosis: a torn cleft in the P2-scallop of the posterior mitral leaflet (PML) with rupture of the chordae. Thus, surgical planning was changed intraoperatively to MV repair (MVRep) consisting of patch closure of the PML, commissurotomy, and lifting annuloplasty. The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making.
Subject(s)
Adult , Female , Humans , Pregnancy , Balloon Valvuloplasty , Diagnosis , Echocardiography , Echocardiography, Transesophageal , Lifting , Mitral Valve Insufficiency , Mitral Valve Stenosis , Mitral Valve , Pathology , RuptureABSTRACT
INTRODUCTION AND HYPOTHESIS: The purpose of this study was to compare the results of the Q-tip test before and after the tension-free vaginal tape-obturator (TVT-O) in women with stress urinary incontinence (SUI) to determine the value of the Q-tip test in predicting the outcome of transobturator tape (TOT). METHODS: Between June 2008 and June 2009, 59 women with SUI who underwent the TVT-O procedure and were followed up for at least 6 months were analyzed. Urethral hypermobility was defined as a maximal straining angle greater than 30° as measured by the Q-tip test. Parameters of evaluation included a comprehensive medical history, physical examination, Q-tip test, stress test, and urodynamic study, which included determination of the Valsalva leak point pressure. Cure was defined as no leakage of urine postoperatively either subjectively or objectively, whereas failure was defined as the objective loss of urine during the stress test. RESULTS: The patients were divided into two groups according to their preoperative Q-tip angle: <30° (group 1, n=21) and ≥30° (group 2, n=38). The Q-tip angle decreased significantly in both groups: from 25.9 ± 5.98° preoperatively to 18.4 ± 7.23° postoperatively in group 1 (p=0.04) and from 36.6 ± 6.75° preoperatively to 24.1 ± 5.48° postoperatively in group 2 (p=0.03). The difference was obviously pronounced in group 2. The incontinence cure rate was significantly higher in group 2 (97.4 %) than in group 1 (85.7 %; p=0.04). CONCLUSIONS: Our results suggest that mobility of the proximal urethra is associated with a high rate of success of the TVT-O procedure.
Subject(s)
Gynecologic Surgical Procedures/methods , Suburethral Slings , Urethra/physiology , Urinary Incontinence, Stress/surgery , Adult , Aged , Female , Follow-Up Studies , Humans , Middle Aged , Postoperative Period , Predictive Value of Tests , Retrospective Studies , Treatment Outcome , Urodynamics/physiologyABSTRACT
No abstract available.
Subject(s)
Humans , Arteries , Arthroplasty, Replacement, Knee , Hemorrhage , Inflation, Economic , Tourniquets , TransplantsABSTRACT
A spontaneous spinal epidural hematoma (SSEH) is a rare disease that accompanies severe axial pain in the spine with various levels of paralysis depending on the location of the hematoma. A SSEH is mainly caused by a coagulating disorder or anticoagulants medication, while certain cases relate this disease with spinal inflammatory conditions. The early diagnosis of a SSEH is important for its treatment. Most cases with neurologic symptoms can be treated with an immediate laminectomy and decompression. If the neurologic symptom improves within 12 hours, a conservative treatment is effective; however few cases have been reported. We report this case with a review of the relevant literature.
Subject(s)
Anticoagulants , Decompression , Early Diagnosis , Hematoma , Hematoma, Epidural, Spinal , Laminectomy , Neurologic Manifestations , Paralysis , Polymethacrylic Acids , Rare Diseases , SpineABSTRACT
OBJECTIVES: It has been reported that first episode polarity affected the course and the prognosis of bipolar disorder. However, there is remarkable paucity of information regarding first episode polarity in bipolar disorder. We investigated the clinical characteristics related to the first episode polarity of bipolar patients who had been hospitalized. METHODS: Analyses were based on the medical documents of 520 bipolar patients who had been hospitalized in 4 hospitals. We examined clinical features of the current episode, demographics, past treatment history, suicidal attempt history, family history and comorbidity. Clinical characteristics were compared between manic onset and depressive onset patients. RESULTS: The mean age of the patients was 36.7 years old; they had 2.1 number of admission history and 6.6 years of illness duration. The patients beginning with depressive onset was 39.4%, and they had more diagnosis of bipolar II disorder, more number of suicidal attempts and reported more depressive mood during index admission than manic onset patients. CONCLUSION: Depressive onset is a common presentation in bipolar disorder. It is necessary to give more attention to depressive episode in bipolar disorder. Prospective study needs to explore the correlation of first-episode of polarity and course of the illness in the future.
