Techniques of Yang’s arthroscopic discopexy for temporomandibular joint rotational anterior disc displacement

Disc displacement is a common disorder affecting the temporomandibular joint. According to previous publications, the displaced disc can be categorized into pure anterior displacement and rotational displacement (anteromedial and anterolateral). However, the technique of arthroscopy treatment has only been reported for patients with pure anterior disc displacement. In this study, an arthroscopic discopexy for rotational anterior disc displacement was developed and its effectiveness evaluated over 24 months of follow-up. A total of 532 patients (749 joints) with rotational anterior disc displacement, admitted to Shanghai Ninth People’s Hospital between January 2011 and December 2015, were included. The success rate was based on clinical parameters (visual analogue scale (VAS) for pain, maximum inter-incisal opening (MIO), and complications) and radiographic data. The clinical and radiographic data were collected preoperatively and at 1, 6, 12, and 24 months postoperative. The VAS score decreased to 0.73 ± 1.43 following surgery (P < 0.001). A significant improvement in MIO (34.73 ± 6.28 mm) was also detected (P < 0.001). Magnetic resonance imaging showed discs repositioned in both sagittal and coronal images for 714 of the 749 joints, giving a success rate of 95.3%. This study reports an effective and predictable technique of arthroscopic discopexy for rotational anterior disc displacement.     

Esophageal positions relative to the left atrium; data from 293 patients before catheter ablation of atrial fibrillation

AimsThree-dimensional rotational angiography (3DRA) of the left atrium (LA) and the esophagus is a simple and safe method for analyzing the relationship between the esophagus and the LA during catheter ablation of atrial fibrillation. The purpose of this study is to describe the location of the esophagus relative to the LA and mobility of the esophagus during ablation procedure.MethodsFrom 3/2011 to 9/2015, 3DRA of the LA and esophagus was performed in 326 patients before catheter ablation of atrial fibrillation. 3DRAwas performed with visualization of the esophagus via peroral administration of a contrast agent. The positions of the esophagus were determined at the beginning of the procedure, for part of patients also at the end of procedure with contrast esophagography.ResultsThe most frequent position is behind the center of the LA (91 pts., 31.9%) The least frequent position is behind the right pulmonary veins (27 pts., 9.4%). The average shift of the esophagus position was 3.36 ± 2.15 mm, 3.59 ± 2.37 mm and 3.67 ± 3.23 mm for superior, middle and inferior segment resp.ConclusionsThe position of the esophagus to the LA is highly variable. The most common position of the esophagus relative to the LA is behind the middle and left part of the posterior wall of the LA. The least frequently observed position is behind the right pulmonary veins. No significant position change of esophagus motion from before to after the ablation procedure in the majority (≥95%) of the patients was observed.     

Digital volume tomography (DVT) as a diagnostic modality of the anterior skull base

Conclusion. Because of high resolution and the relatively lower costs in comparison with modern helical CT scanners, digital volume tomography (DVT) can be recommended in the diagnosis of the nasal cavity and paranasal sinuses. Objectives. DVT is an advancement of panoramic tomography and is based on the principles of rotational tomography. It enables high resolution visualization of osseous structures. The slices can be displayed in three orthogonal planes that can be changed in angle arbitrarily. Data volumes of up to 12×17 cm can be examined with a new generation of the DVT. The aim of this study was to point out the potential of DVT in the anterior skull base. Subjects and methods. DVT scans with a cylindrical size of 10 cm in diameter and 10 cm in height were performed in 23 patients. The identification of surgical key landmarks (uncinate process, middle turbinate, ethmoidal bulla, agger nasi cells, Haller cells, frontal recess, anterior ethmoidal artery in its relationship to the skull base, the cribiform plate of the sphenoidal sinus in relation to the optic nerve, and the internal carotid artery) was evaluated. Results. Display of the essential surgical key landmarks was possible in all patients     

多排螺旋冠脉CT对老年人冠心病的临床价值研究

目的 :探讨64排螺旋CT冠脉成像在老年人冠心病的临床诊断价值。方法 :选取我院2009年1月~2013年12月收治的临床诊断或怀疑老年冠心病患者80例,先后进行64排螺旋CT冠脉成像和常规冠脉造影,统计64排螺旋CT冠脉成像在检测冠心病中敏感性,特异性及诊断准确性。结果 :以冠状动脉分支为基准,与金标准相比,64排螺旋CT诊断冠状动脉狭窄中度以及重度的总敏感性为92.9%,特异性为96.7%,阳性预测值为91.9%,阴性预测值为84.7%,准确度为95.3%;以冠状动脉节段为基准,64排螺旋CT诊断冠状动脉狭窄中度以及重度的总敏感性为95%,特异性为98.1%,阳性预测值为95.4%,阴性预测值为98%,准确度为97.2%。结论 :64排螺旋CT冠脉成像不仅敏感性、特异性以及诊断准确性高,而且无创,是老年人冠心病患者的首选诊断方法,值得临床推广使用。     

Insufficient tissue ablation by rotational atherectomy leads to worse long-term results in comparison with balloon angioplasty alone for the treatment of diffuse in-stent restenosis: insights from the intravascular ultrasound substudy of the ARTIST randomized multicenter trial.

The ARTIST trial demonstrated a worse outcome for patients with in-stent restenosis (ISR) treated with rotational atherectomy (RA) and adjunctive balloon angioplasty (PTCA) as compared to PTCA alone. This intravascular ultrasound (IVUS) substudy compares effects of lumen enlargement and examines reasons for failure of RA in this setting. IVUS (n = 56) was performed after each interventional step and at follow-up. Volumetric lumen gain measured 79 +/- 68 mm(3) after PTCA (13 +/- 4 atm) as compared to 44 +/- 26 mm(3) after RA and adjunctive PTCA (7 +/- 3 atm; P < 0.0001). RA itself enlarged lumen by only 19 +/- 17 mm(3) and stent volume was 47% smaller as compared to high-pressure PTCA. Low-pressure strategy after RA did not prevent tissue growth during follow-up (19 +/- 25 vs. 36 +/- 38 mm(3); RA vs. PTCA; P = 0.09). Consequently, net lumen gain after PTCA was 82% higher compared to RA (46 +/- 54 vs. 25 +/- 24 mm(3); P = 0.09). Further stent expansion is the key mechanism to achieve luminal gain by PTCA of ISR. Neointimal ablation by RA has only minor effects. Low-pressure PTCA does not prevent recurrent tissue growth and failed for treatment of ISR due to insufficient stent expansion.     

Hyperacute Management of Ischemic Strokes: JACC Focus Seminar

Acute ischemic stroke is the leading cause of disability and among the leading causes of mortality worldwide. Intravenous tissue plasminogen activator has been a cornerstone for treatment of acute ischemic stroke for more than 20 years; however, its use is limited due to a narrow therapeutic window, several contraindications, and low efficacy to recanalize the artery in large vessel occlusion. Recently, the addition of endovascular mechanical thrombectomy of large artery occlusion has revolutionized the stroke treatment for most disabling strokes. The paper reviews updates to the thrombolytic treatment as well as catheter-based treatment, and results from recent trials in the selection of patients in an extended time window using perfusion imaging.     

Rotational Flap Repair of Full Thickness Eyelid Defects without a Posterior Lamellar Graft or Flap

Background: To determine the safety and effectiveness of full thickness eyelid reconstructions using a semicircular rotational flap without reconstructing the posterior lamella.

Methods: The charts of all patients undergoing semicircular flap closure of full thickness eyelid defects by one surgeon (JDP) at the Cole Eye Institute between March 2000 and October 2012 were reviewed. Charts were reviewed for patient demographic information, as well as for the size of the defect, the type of flap used, length of follow-up and complications.

Results: Fifty eyelids of 50 patients underwent a semicircular flap repair without posterior lamellar reconstruction during the study period, and 41 charts were available for review. Average patient age was 74 years (range, 40–92 years). Average follow-up was 9.8 months (range, 1–84 months). Average defect size was 19.1?mm (range, 14–30?mm, SD 4.6). Complications included pyogenic granuloma (10 patients, 24.4%), exposure keratopathy (7 patients, 17.1%) lagophthalmos (5 patients, 12.2%), ectropion (6 patients, 14.6%), lateral canthal dystopia (2 cases, 4.9%), eyelid notch (2 cases, 4.9%) and trichiasis (4 cases, 9.8%). Two patients underwent subsequent tarsorrhaphy and one patient underwent ectropion repair. There were no cases of wound dehiscence, diplopia or fornix inadequacy, and the recruited aspect of the eyelid healed well in each case. No case required reconstruction of the eyelid margin or fornix.

Conclusions: Semicircular flap repair of full thickness eyelid defects without flap or graft repair of the posterior lamella results in an adequate fornix and a low rate of secondary surgery.     

成角近段旋磨对严重钙化成角冠状动脉病变的治疗价值

目的:在严重钙化成角冠状动脉(冠脉)病变患者中,对比成角近段旋磨和全程旋磨的手术成功率、术中并发症及临床预后,评估成角近段旋磨对该类病变的治疗价值。方法:连续纳入我院2017年1月至2019年12月接受冠脉旋磨介入治疗且冠脉均存在严重钙化伴成角(≥45°)的患者共245例,依据旋磨手术策略分为全程旋磨组(n=179)和成角近段旋磨组(n=66)。比较两组手术成功率和术中并发症发生率,观察两组患者的临床转归,观察终点包括院内和1年主要不良心血管事件(MACE,包括心原性死亡、靶血管再次血运重建、支架内血栓)发生率。结果:成角近段旋磨组的手术成功率为97.0%,2例(3.0%)患者因术中球囊无法扩张而最终转换为全程旋磨;全程旋磨组的手术成功率为99.4%,1例(0.6%)患者因冠脉穿孔导致手术失败而行急诊冠脉旁路移植术。全程旋磨组发生旋磨头嵌顿和心包填塞各2例(1.1%)、冠脉穿孔4例(2.2%),而成角近段旋磨组未出现这些严重并发症;两组术中慢血流/无复流的发生率差异无统计学意义(P>0.05),但全程旋磨组术中冠脉夹层的发生率显著高于成角近段旋磨组(43.6%vs.19.7%,P<0.05)。两组的院内总MACE发生率相当,但全程旋磨组1年MACE发生率明显高于成角近段旋磨组(27.4%vs.13.6%,P<0.05)。结论:对于严重钙化伴成角的冠脉病变,成角近段旋磨联合球囊扩张的手术成功率和临床转归与全程旋磨相似,而术中并发症尤其严重并发症的发生风险明显低于后者,说明仅采用成角近段旋磨治疗此类病变是安全和有效的。