Optimized strategy of rotational atherectomy of underexpanded coronary stents in patients with acute coronary syndrome.

BACKGROUND: Stent under-expansion is a main cause of acute coronary syndrome (ACS), which can lead to serious clinical outcomes. The rotational atherectomy of underexpanded coronary stents (academically called stent ablation, SA) by intravascular ultrasound (IVUS) may provide more visual reference in the intervention. We aim to analyze the procedural and long-term outcomes of the optimized strategy of SA in patients with ACS and to provide real-world data on this technique. METHODS: A total of 11 patients with ACS who underwent SA between April 2017 and January 2019 were analyzed. Clinical follow-ups were obtained either by telephone call or by scheduled visit. Clinical end-points included periprocedural and postprocedural myocardial infarction, stent thrombosis, target lesion revascularization, and major adverse cardiac events. RESULTS: The mean age of patients was 69.6±6.5 years, and five (45.5%) patients were males. All cases presented with unstable angina and were admitted with ACS. All patients required at least two burrs during the intervention and the size of the burr was selected based on the data of minimum lumen diameter (MLD), and the first and the second burr/stent MLD ratios were 0.93 (0.88-0.99) and 1.09 (1.02-1.14), respectively. Nine patients were treated with drug-eluting stents and two were treated with drug-coated balloons. There were no complications including no flow, perforation, or burr entrapment during the intervention. No in-hospital deaths or major adverse cardiac events were documented during the follow-up period. In our study, less contrast agent and a lower dose of radiation were used during the intervention. CONCLUSIONS: SA guided by IVUS can reduce the risk of complications, assess the results of surgery, inform the selection of stent size, and decrease the required dose of radiation and contrast.

Microsurgical efficacy in 326 children with tethered cord syndrome: a retrospective analysis.

Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely intervention. The purpose of this study was to investigate the curative effect of microsurgery in children with different types of tethered cord syndrome. In this study, we analyzed 326 patients with tethered cord syndrome, aged from 2 months to 14 years old, who were followed for 3-36 months after microscopic surgery. Based on clinical manifestations and imaging findings, these patients were classified into five types: tight filum terminale (53 cases), lipomyelomeningocele (55 cases), lipomatous malformation (124 cases), postoperative adhesions (56 cases), and split cord malformation (38 cases). All patients underwent microsurgery. Curative effects were measured before and 3 months after surgery by Spina Bifida Neurological Scale based on sensory and motor functions, reflexes, and bladder and bowel function. The results showed that Spina Bifida Neurological Scale scores improved in all five types after surgery. Overall effective rates in these patients were 75%. Effective rates were 91% in tight filum terminale, 84% in lipomyelomeningocele, 65% in lipomatous malformation, 75% in postoperative adhesion, and 79% in split cord malformation. Binary logistic regression analysis revealed that types of tethered cord syndrome (lipoma-type or not) and symptom duration before surgery were independent influencing factors of surgical outcome. These results show that therapeutic effect is markedly different in patients with different types of tethered cord syndrome. Suitable clinical classification for tethered cord syndrome will be helpful in predicting prognosis and guiding treatment. This trial has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800016464).

Reconstruction of the postauricular defects using retroauricular artery perforator-based island flaps: Anatomical study and clinical report.

The objectives of the study were to introduce and investigate the reliability of a new flap for postauricular defects using the retroauricular artery perforator.Twenty auricles from 10 Asian human cadavers were dissected to examine the retroauricular perforator distribution and diameter. Fourteen patients with postauricular defects underwent reconstruction using the retroauricular artery perforator from 2013 to 2015. After locating the position of the perforator by ultrasound Doppler blood flow detection, a suitable flap was designed according to the defect's size, condition, and distance from the pedicle. The flap was meticulously elevated, rotated appropriately, and sutured to the defect. The donor site was then closed.Cadaver dissection showed that the posterior auricular artery produces at least 2 constant branches with an external diameter of 0.84 ±â€Š0.25 mm at the origin. These branches proceed toward the mastoid process at the height of the auriculocephalic angle to nourish the skin and fascia. A total of 14 clinical cases were available for 3 to 12 months postoperative follow-up. All flaps survived completely, maintaining good skin color, perfect outer contour, and complete patient satisfaction with the aesthetic results after initial treatment.Retroauricular artery perforator-based island flaps appear to be ideal for 1-stage reconstruction of postauricular skin defects.

[Thoracic extramedullary subdural and epidural of inflammatory myofibroblastoma: a case report].

We present here a rare case of thoracic extramedullary subdural and epidural of leisions. The initial diagnosis of preoperation was hypertrophy of ligamentum flavum, however, after excision of the epidural lesions, the symptoms got worse. A second operation found the subdural leisions which were then totally resected. Two pathological examinations confirmed it was inflammatory myofibroblastic tumor (IMT). The incidence of this disease is extremely low. IMT is benign in histology, but it can be aggressive. The exact pathogenesis is still unknown. Tumor resection is the first choice to treat. Long-term follow-up with MRI is required for the patient.

Safety and efficacy of microscope-assisted insertion of screws into fused C1-occipital condyle complex for occipital cervical fixation in atlantal cervical nonsegmentation patients.

OBJECTIVE: To explore the safety and efficacy of the insertion of screws into fused C1-occipital condyle(CC)complex without image guidance in atlantal-cervical nonsegmentation patients. METHODS: The occipital condyle junction was fixed posteriorly in 10 basilar invagination patients with atlantal-cervical nonsegmentation using polyaxial titanium screws(3.5 mm)inserted unicortically into the CC complex and C2 pedicles,followed by fixation to a 3 mm rod. Drilling was guided by anatomic landmarks. The entry point was at the center of posterior surface of the CC complex. The angle of medicalization was 10-15 degrees. In the sagittal plane,the angle for maximal superior screw angulation was also 10-15 degrees. The screw length to obtain unicortical purchase was 16 to 22 mm. CT scans were obtained before and after the surgery. The length,width,and height of CC complex were measured on computed tomography(CT)preoperatively. The position of screws and the condition of fixation were analyzed on postoperative CT scan. Postoperative complications were recorded. The mean follow-up was(30.2±4.38)months(range: 24-36 months). RESULTS: The width,length,height of left side CC complex were(7.96±2.23)mm,(16.06±2.73)mm,and(13.76±2.06)mm,and the width,length,height of right side CC complex were(7.84±1.38)mm,(16.66±2.58)mm,and(12.81±2.62)mm. No fracture was identified. There was no screw malposition or neurovascular complication related to screw insertion. No screw loosening or construct failure was observed during the follow-up. CONCLUSIONS: In patients with atlantal cervical nonsegmentation,the CC complex screws can be safely inserted assisted by microscope without image guidance. Occipital condyle junction fixation using polyaxial CC complex screws is feasible and can be a good alternative where other fixation techniques are not satisfactory.

Posterior realignment of irreducible atlantoaxial dislocation with C1-C2 screw and rod system: a technique of direct reduction and fixation.

BACKGROUND CONTEXT: Treatment of chronic and irreducible atlantoaxial dislocation (AAD) with ventral compression is challenging for surgeons. The main procedures are occipitocervical/C1-C2 fusion after transoral odontoidectomy or release of the periodontoid tissues. These surgical procedures, which are performed simultaneously or intermittently, have many disadvantages that may discount their effectiveness. Therefore, a more effective way to achieve surgical reduction and to keep solid stability with only a single procedure is needed. PURPOSE: We describe a technique to reduce chronic and irreducible AAD with C1 lateral mass and C2 pedicle screw and rod system. STUDY DESIGN: This was a retrospective case series. PATIENT SAMPLE: Our sample comprised 26 patients (9 men and 17 women) with irreducible AAD who ranged in age from 15 to 54 years (mean, 35 years). OUTCOME MEASURES: Patients' neurologic status was evaluated with the Japanese Orthopedic Association (JOA) scale. METHODS: Twenty-six symptomatic patients underwent posterior realignment and reduction through the C1 lateral mass and C2 pedicle screw and rod system. The proposed mechanism of reduction is that the implanted screws and rods between C1 and C2 acting as a lever system drew C1 backward and pushed C2 downward and forward after removing circumambient obstruction and scars and thoroughly releasing the facet joints. The preoperative and postoperative JOA score, the extent of reduction, and the conditions of C1-C2 bony fusion were examined. RESULTS: No neurovascular injury occurred during surgery. Follow-up ranged from 6 to 40 months (mean 20.7 months). Radiographic evaluation showed that solid bony fusion was achieved in all patients, and that complete reduction was attained in 18 patients and partial reduction (>60% reduction) in 8 patients. The mean postoperative JOA score at last follow-up was 15.7, compared with the preoperative score of 12.1 (p<.01). CONCLUSIONS: This C1-C2 screw and rod system provides reliable stability and sufficient reduction of the anatomic malalignment at the craniovertebral junction and meanwhile retains the mobility of atlanto-occipital joints in the treatment of chronic and irreducible AAD. Sophisticated skills, thorough release of the facet joints, and intraoperative protection of the vertebral artery are key points to accomplish this technique.

Three-dimensional configuration and morphometric analysis of the lateral atlantoaxial articulation in congenital anomaly with occipitalization of the atlas.

STUDY DESIGN: Observational and quantitative study with 3-dimensional (3D) computerized tomographic (CT) analysis. OBJECTIVE: To establish the 3D configuration and morphometric data of obliquity of the lateral atlantoaxial articulations (LAA) in congenital anomaly with occipitalization. SUMMARY OF BACKGROUND DATA: Plane radiographs and normal CT scans cannot clearly demonstrate the configuration of LAA as the hindrance of circumambient bony structures. The morphology of anomalous LAA with occipitalization is underreported. METHODS: A series of 63 cases with occipitalization and 20 control subjects underwent thin-slice CT scanning. The 3D configuration of LAA were analyzed and categorized based on the degree of olisthy and inclination orientation of the atlantoaxial articular facets (AAF). The obliquity of the AAF was measured in reconstructed sagittal and coronal planes, respectively. RESULTS: Four types of configuration of LAA with occipitalization were found: type I, characterized by slight anteversion of LAA without olisthy of the inferior and superior facets (16% of 126 sides); type II, characterized by partial olisthy of the 2 facets and evident anteversion of LAA (48%); type III, defined by the separation or complete olisthy of the 2 facets (13%); and type IV, wherein the articular facets sloped dorsally (23%). Forty-eight of 49 cases in the former 3 types wherein AAF sloped ventrally had atlantoaxial dislocation (AAD). All type IV cases wherein AAF sloped dorsally had no AAD. In control subjects, LAA had no evident obliquity of anteversion or retroversion. CONCLUSION: Instability at the C1-C2 junction in congenital anomaly with occipitalization is likely a direct result of the anteversion of LAA and bony malformation of this region, and it aggratates with the increasing obliquity of anteversion of the AAF. Demonstrating 3D morphological changes of LAA may provide a new means to diagnosis instability in congenital anomaly at craniovertebral junction and a basis for rational surgical treatment.

[Applying competitive polymerase chain reaction to the detection of hepatitis B virus DNA].

OBJECTIVE: To reduce the rate of accidental false negative result in the HBV DNA PCR test on clinical serum samples. METHODS: A competitive polymerase chain reaction (C-PCR) was used to decrease the false negative ratio. In the C-PCR, a constructed inner control DNA was added for co-amplification with the HBV target DNA. RESULTS: In a 20 microl C-PCR system, about 60 to 200 copies of inner control DNA could give apparent co-amplification signal band after electrophoresis on a 2% agarose gel. Five of 120 samples of clinical serum (4.2%) could not be amplified. CONCLUSION: C-PCR has the advantage of yielding information on false negative in the HBV DNA PCR assay of clinical serum samples.