Retropublic colpourethropexy with transabdominal anterior and/or posterior repair for the treatment of genuine stress urinary incontinence and genital prolapse

A new operative technique combining retropublic colpourethropexy with transabdominal internal anterior and/or internal posterior repair for the treatment of genuine stress incontinence (GSI) and genital prolapse is described in 75 cases. The overall success rate in correcting GSI was 92.0%, with a 94.8% success rate in the primary surgical group (n=58) and an 82.4% in the secondary group (n=17). Average follow-up has been 1.31 years (range 6 weeks–6 years). There was a 3.4% incidence of residual prolapse. Nine patients also underwent concomitant colpourethropexy. Overall surgical complications include febrile morbidity 4/75 (5.3%), wound infection 1/75 (1.3%), deep vein thrombosis 1/75 (1.3%) and partial ureteric obstruction 1/75 (1.3%). There were no statistically significant changes in multichannel urodynamic studies preoperatively and at 1 year following surgery. Onethird (2/6) of the GSI failures had low MUCP (<20 cm H₂O) prior to surgery and continued so at 1 year follow-up.EDITORIAL COMMENT: Genital prolapse is often present in patients who have GSI. If an operation is performed to correct the GSI, and those areas of weakness in the pelvic support system that are contributing to the genital prolapse are not treated, the genital prolapse will become more severe. In the operation which has been described, the colpopexy sutures will correct any cystourethrocele, and the removal of the wedge of tissue from the anterior superior vaginal wall will correct the cystocele. The removal of the wedge of tissue from the posterior superior vaginal wall will reduce the redundancy of the posterior vaginal fornix, but a culdeplasty of the Moschcowitz or Halban type is recommended to treat or prevent an enterocele and to place the vaginal apex in the hollow of the sacrum. Any coexistent rectocele must always be treated vaginally. If it is not treated, it will appear to be more advanced following elevation of the anterior vaginal wall by retropubic urethropexy and the anterior repair which has been recommended.Genital prolapse is best treated by a vaginal approach. When one must une an abdominal approach, ancillary procedures such as the authors have described should be considered. A bulbous upper vagina is ideal for childbearing but if the apical support system and vaginal wall is weakened it is predisposed to prolapse. If the surgeon, in operating for genital prolapse, which involves the upper vagina, will taper the vaginal apex and support it by obliteration of the cul-desac and shortening and reattachment of the uterosacralcardinal complex, postoperative prolapse will be less likely to recur.     

The immobilization response in rhesus monkey: a behavioral and electroencephalographic study.

Rhesus monkeys maintained in individual cages are rarely inactive when observed by humans unfamiliar to them. It has been observed that these animals display a greatly reduced behavioral repertoire after they are transferred to primate chairs. The present study used systemic behavioral observations to document those changes and to examine additional changes produced by arm restraint. Chair restraint was associated with a reduction in activity which was intensified when animals were further immobilized by arm restraint. This immobilization produced a reduction of tone in all limbs, a reduction of spontaneous behavior, and the appearance of eye closure. Electroencephalographic (EEG) correlates of the behavioral changes were examined also, using quantitative data generated through power spectral analysis of sensorimotor cortical EEG signals. Immobilization was accompanied by a significant increase in spectral density at 12 to 15 Hz which was most marked at mid and far lateral rholandic recording sites. No other significant changes were seen in the frequency bands studied. When the immobilized animal was alerted with novel stimuli, lower frequencies were attenuated but 12- to 15-Hz activity remained enhanced. These findings indicate that a unique immobilization response is elicited by restraint in the rhesus monkey which is associated with discrete changes in both behavior and accompanying EEG patterns.     

四种小儿动脉导管未闭堵闭术的临床应用:附127例报告

本文采用四种不同的介入治疗方法堵闭动脉导管共127例,成功率海绵塞法为92％(23/25例),双面伞器法为98.6％(66/67例),钮扣式补片法为100％(26/26例),弹簧圈器法为100％(9/9例)。海绵塞法和弹簧圈器无残余分流;术后6个月双面伞器法残余分流为7％(5/67例),钮扣式补片法为15％(4/26例)。钮扣式补片法和弹簧圈器法无并发症,海绵塞法为24％(6/25例),双面伞器法为4％(3/67例)。我们认为,钮扣式补片法及弹簧圈器法在小儿动脉导管未闭的介入治疗中具有较大的应用价值。     

Aortic Stenosis and Patent Ductus Arteriosus: Pressure Gradients Pre- and Posttranscatheter Ductal Occlusion

Three patients with patent ductus arteriosus and moderate aortic stenosis had a marked reduction in aortic valve gradient following transcatheter ductal occlusion. The hemodynamic effects of an aortopulmonary shunt on the severity of left ventricular outflow obstruction and the implications on intervention are discussed.     

经导管Amplatzer封堵器和外科手术治疗动脉导管未闭对照试验的Meta分析

目的评估经导管Amplatzer封堵器治疗动脉导管未闭(PDA)的疗效,为临床应用提供指导。方法采用Meta分析方法,对国内外有关经导管Amplatzer封堵器和外科手术治疗PDA的对比临床研究进行综合定量分析,采用RevMan4.2.2软件进行数据处理,计算各组技术失败率、并发症及严重并发症发生率、残余分流率等的相对危险度(RR)及其95%可信区间(CI)。结果符合纳入标准共5篇文献,总样本量349例。经导管Amplatzer封堵器组技术失败率高于外科手术组[5组对照试验(CT),349例,3.0%vs0,RR=4.29,95%CI(0.77,23.95)],但无显著性差异(P=0.10);并发症发生率低于外科手术[5组CT,343例,3.1%vs38.0%,RR=0.11,95%CI(0.05,0.23)](P<0.00001);严重并发症发生率显著低于手术组[5组CT,343例,0.5%vs6.0%,RR=0.23,95%CI(0.06,0.90)](P=0.03);Amplatzer封堵器组治疗后即时残余分流率高于手术组[4组CT,304例,16.3%vs0,RR=16.06,95%CI(3.0,86.12)](P=0.001);出院时残余分流率虽高于手术组,但无显著性差异(2.5%vs0,P=0.33)。结论经导管Amplatzer封堵器治疗PDA尽管成功率低于外科手术,但其创伤小、并发症发生率低、疗效与手术相仿,随着封堵器及其输送系统的不断改进和完善,在适应证范围内经导管Amplatzer封堵器治疗可作为PDA外科手术治疗的替代方法。     

Use of Gamma-Irradiated Cornea to Plug Sclerostomy Site During Tube Shunt Revision

Tube shunt implantation is a common procedure for control of intraocular pressure (IOP). However, tube revision and repositioning must sometimes be performed, and this involves removing the tube from its sclerostomy site. This site is prone to leaking and this may cause postoperative hypotony. We describe a novel and cosmetically acceptable technique of plugging and covering the sclerostomy site with gamma-irradiated corneal tissue.     

Role of pilocarpine use following laser peripheral iridotomy in eyes with refractory acute angle closure glaucoma: A case report and literature review

Rationale:Angle closure glaucoma (ACG) is one of the most emergent types of glaucoma in clinical practice. Laser peripheral iridotomy (LPI) could minimize pupillary block and prevent ACG from an acute attack. However, recurrent increase in intraocular pressure (IOP) may still occur despite successful LPI. The aim of this study is to highlight the importance of postLPI pilocarpine use and larger LPI size as well as to share some experiences of cataract surgery in patients with ACG.Patient concerns:A 63-year-old female was referred to our hospital for headache, and poor control of IOP in the right eye for 3 hours.Diagnoses:The patient was diagnosed ACG in the right eye. Recurrence of ACG in the right eye and new-onset and recurrent ACG in the left eye were noted during follow-up, despite successful LPI. The diagnosis was confirmed through slit lamp and gonioscope examination.Interventions:The LPI size was enlarged and pilocarpine use was maintained at 2% (1 drop 4 times a day) in both the eyes. Finally, cataract surgery was performed in both the eyes.Outcomes:No recurrence of ACG was noted during postLPI pilocarpine use in both the eyes. The postoperative IOP was stable for >6 months after cataract surgery without any surgical intervention or antiglaucoma medication use. No discomfort or major complication was observed.Conclusion:This report highlights the importance of postLPI pilocarpine use and larger LPI size in patients with refractory ACG.     

Feasibility of open chest management with modified negative pressure wound therapy immediately after cardiac surgery

OBJECTIVESTo evaluate the feasibility of open chest management with our modified negative pressure wound therapy immediately after cardiac surgery as a therapy for atypical tamponade.METHODSOpen chest with modified negative pressure wound therapy was performed immediately after cardiac surgery. The surface of the heart and the vessels were covered with non-adherent siliconized gauze. The sternal halves were stented using edge-cut disposable syringes to maintain a larger mediastinal cavity. Approximately 45 mm of distance was kept between the sternal edges. A trimmed sterile polyvinyl foam sponge was inserted into the mediastinum, the entire wound was sealed and negative pressure (−50 to −75 mmHg) was applied using a suction generator. Delayed chest closure was performed in a standard manner once the haemodynamic status was stabilizsed.RESULTSThe mortality rate was 3/15 (20%) patients. Deep sternal wound infection occurred in 1/15 (6.7%) patients. Five patients were extubated during the open chest management. Sternal closure was delayed for median of 3 days after the initial surgery. There was no incidence of bleeding complications or need for additional haemostatic procedures.CONCLUSIONSNegative pressure wound therapy performed immediately after cardiac surgery was feasible in our small number of patients.Clinical registration numberStudy ID: 2020-149.     

房间隔缺损介入封堵术并发三度房室传导阻滞一例

患儿,女,5岁,体重19kg。体检发现先天性心脏病:房间隔缺损于2007年4月9日入院。病程中无紫绀、呼吸困难,无蹲踞现象,无发育迟缓,近1个月来无发热咳嗽。心脏听诊:心率:110次/min,律齐,胸骨左缘2～3肋间可闻及2级收缩早期杂音,P2无亢进。心电图:窦性心律,不完全性右束支传导阻滞。心脏常规片:两肺纹增多,心前间隙狭窄。心脏彩超:先天性心脏病:房间隔缺损,左向右分流,右室比例增大。心尖四腔心切面:缺损大小13mm,距左房室10mm,距后上     

Full thickness open tear of the tendoachilles - Functional outcomes following a stable,single stage repair

ObjectiveOpen injuries of the Tendoachilles present a challenge to the treating surgeon. Although, common in our setting, there is a paucity of literature regarding management of the same. The purpose of this retrospective study was to analyse the functional outcomes following debridement and primary repair of open tears of the Tendoachilles.Materials and methodsPatients with open tears of the tendoachilles, between January 2012 to January 2017. After obtaining demographic data, including mechanism of injury, all patients were managed by adequate debridement and primary repair, by Pennington’s modification of Kessler’s technique in a single sitting, paratenon closed circumferentially, plantaris reinforcement used when end to end repair couldn’t be achieved. Below knee cast for 2 months. Weight bearing started at three months. Statistical analysis using paired t-test for calf circumference, ankle range of motion comparing with uninjured limb. Functional outcome assessment by AOFAS hindfoot score and Achilles tendon rupture score.Results23 male patients, mean age 35, were analysed. Field injury was the most common mechanism, with slip in Indian lavatory pans accounting for four patients. Average time to surgery from injury was 22 hours. Plantaris reinforcement in one case. No case of wound dehiscence, scar adherence, tendon rerupture or infection. One patient had serous discharge at three weeks which settled with oral antibiotics. 21 patients performed single heel raise. There was no significant difference in calf circumference and ankle range of motion compared to uninjured limb. Mean AOFAS score was 92, mean Achilles tendon rupture score 77.ConclusionThough open injuries of the tendoachilles is fraught with complications, early debridement, adequate repair of the tendon edges with circumferential closure of the paratenon, yields adequate functional outcomes with minimal complications.