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At least 793 records · Page 44Linked to original sources
PubMed1996

Needle elevation of the scleral flap for failing filtration blebs after trabeculectomy with mitomycin C.

PURPOSE: To report the incidence of failing filtration blebs after trabeculectomy with mitomycin C and to report the outcome of needling procedures for failing filtration blebs in these eyes. METHODS: We conducted a retrospective analysis of 537 eyes of 434 patients who had trabeculectomy with mitomycin C and reviewed the clinical course of 441 eyes of 338 patients with a minimum of three months of follow-up. RESULTS: In 441 eyes of 338 patients followed up for three months or more after trabeculectomy with mitomycin C, 88 (20.0%) eyes from 85 patients underwent needle elevation of the scleral flap. Forty-nine (22.4%) of 219 eyes required needle revision after trabeculectomy alone, and 39 (17.6%) of 222 eyes after trabeculectomy combined with cataract extraction and intraocular lens implantation. Mean intraocular pressure (IOP) after needle revision (17.9 +/- 11.6 mm Hg) was significantly less than the mean preneedling IOP (27.1 +/- 10.4 mm Hg, P < .00001, paired Student's t test). Sixty-three eyes of 60 patients had a minimum of three months of postneedling follow-up. Successful pressure control, defined as an IOP of 22 mm Hg or less with or without topical glaucoma control medications, was achieved in 46 (73.0%) of 63 eyes. Unsuccessful outcomes correlated significantly with higher preneedling IOP (R = 0.28, P = .03, df = 61) and prior surgery involving conjunctival incisions (R = 0.53, P < .00001, df = 61). CONCLUSIONS: Needle elevation of the scleral flap may provide significantly long-lasting pressure reduction in eyes with failing mitomycin C blebs. Higher success rates are achieved in eyes with fewer prior conjunctival incisions, eyes requiring a single needle revision, and eyes with lower preneedling IOP.

Adult↗
PubMed1996

Histopathologic and immunohistochemical analysis of the filtration bleb after unsuccessful glaucoma seton implantation.

PURPOSE: To analyze histopathologically and immunohistochemically the filtration bleb after unsuccessful glaucoma seton implantation. METHODS: A von Denffer implant and two Molteno implants that were nonfunctional at three months, at 11 months, and at five years after implantation, respectively, were compared by evaluating the adjacent bleb with light microscopy and a panel of 11 antibodies to epithelial, mesenchymal, and inflammatory cells. RESULTS: The wall of the filtration bleb three months after implantation consisted of loosely arranged collagenous connective tissue with relatively abundant fibroblasts labeled with monoclonal antibodies (MAbs) V9 and Vim 3B4 to vimentin. At 11 months and at five years, the collagenous layers had become increasingly thick and the fibroblasts scarce. All blebs showed metaplastic myofibroblasts surrounded by tenascin, as identified by MAb 1A4 to alpha-smooth muscle actin and TN2 to tenascin, respectively. One bleb was lined by a monolayer of cells that reacted with MAb CAM 5.2 and CY-90 to cytokeratin 8 and 18, respectively, and was apparently derived from the identically reacting proliferating corneal endothelial cells. Another bleb harbored many macrophages and foreign-body giant cells. Little evidence of chronic inflammation around the seton was detected. CONCLUSIONS: A glaucoma seton may induce several processes that potentially decrease filtration. In addition to formation of a collagenous cyst, presence of myofibroblasts suggests long-standing scar modulation that potentially leads to compaction of the filtration membrane. Furthermore, macrophages and corneal endothelial cells may invade the filtration bleb.

Adult↗
PubMed1995

Use of the Hoskins lens in needle revision of a failed bleb after filtration surgery.

PURPOSE/METHODS: During needle revision of a failed bleb after filtration surgery, a needle is inserted through the conjunctiva and a Hoskins lens is placed on the conjunctiva over the needle. The lens blanches the conjunctival vessels and the needle tip can be pinpointed. RESULTS/CONCLUSION: This procedure has been performed in nine eyes with no major complications. Needle revision of a failed bleb can be performed efficiently with the Hoskins lens.

Filtering Surgery↗
PubMed1996

Simultaneous silicone intubation through the osteotomy and the nasolacrimal duct during dacryocystorhinostomy.

PURPOSE: To determine whether simultaneous silicone intubation of the osteotomy and the nasolacrimal duct is advantageous in some dacryocystorhinostomy procedures. METHODS: Silicone tubing was placed through both the osteotomy and the nasolacrimal duct in two patients who underwent dacryocystorhinostomy for dacryolithiasis. RESULTS: Postoperatively, signs and symptoms of nasolacrimal obstruction were relieved, and lacrimal irrigation confirmed anatomic patency of the tear drainage canals in both cases. CONCLUSIONS: Simultaneous intubation of the osteotomy and the nasolacrimal duct prevents prolapse of the silicone stent and may decrease the frequency of postoperative scarring.

Dacryocystorhinostomy↗
PubMed1988

Rehabilitation of the cancer patient.

Cancer patients often require extensive rehabilitation after treatment. Organization of a rehabilitation team and determination of its goals are a primary aim of such programs. Studies of job security and insurability demonstrate significant problems and biases toward the cancer patient. Discussion has been made of specific male and female sexual rehabilitation programs as well as programs directed at other physical disabilities secondary to head and neck or amputation surgery. Attention is drawn toward familiarizing the surgeon with these problems in order to enhance his treatment of the cancer patient.

Absenteeism↗
PubMed2002

[Surgical treatment of acute pancreatitic with infected necrosis by necrosectomy-pancreatostomy].

UNLABELLED: Technical modalities of surgical treatment of infected pancreatic necrosis remains controversial. The aim of this retrospective study was to assess the results of necrosectomy associated by pancreatostomy using active drainage according Mikulicz, which is currently an unusual technique. PATIENTS AND METHODS: From 1985 to 1997, 18 consecutive patients (median age = 63; range = 35-88 years) were operated on through laparotomy for infected necrosis and treated by necrosectomy combined with Mikulicz drainage. Fourteen patients were referred from another center, including 9 who had previous surgery. Necrosectomy was performed after a median delay of 22 days (1-45) after onset of pancreatitis, in all patients because of severe sepsis (including 12 patients with persisting shock) and presence at CT scan of necrotic collections containing gas bubbles (n = 15) and/or infection proven by percutaneous aspiration (n = 3). RESULTS: After the first procedure, patients underwent between 2 and 25 (median: 5) additional necrosectomies through the pancreatostomy tract. Thirteen surgical complications were observed in 8 patients: digestive fistula (n = 7), intraabdominal bleeding (n = 3), gastrointestinal haemorrhage (n = 1), colic stenosis with colectasy (n = 1). Five patients, all referred from another center, died (28%) between the 47th and the 140th day from multiorgan failure (n = 4) or gastrointestinal haemorrhage (n = 1). The median hospital stay was 109 days (26-265) including 51 in intensive care unit (1-134). The 13 surviving patients were followed during an average of 2 years (4 months-7 years). All developed an incisional hernia of the pancreatostomy tract, which was surgically treated in 6 cases. CONCLUSIONS: Necrosectomy-pancreatostomy is an appropriate treatment of acute pancreatitis with infected necrosis, despite the usual need of additional but easy necrosectomies, and the frequent occurrence of incisional hernia. Results observed in patients referred to our center suggest that earlier diagnosis of necrosis infection using percutaneous aspiration could improve the prognosis.

Adult↗
PubMed2006

Review of consecutive phacotrabeculectomies supplemented with early needle revision and antimetabolites.

BACKGROUND: To describe the results of a novel postoperative management approach for patients undergoing combined cataract and glaucoma surgery supplemented with early needle revision and antimetabolites. METHODS: Consecutive retrospective chart review identified 66 patients who had undergone combined cataract and glaucoma surgery with early needling and antimetabolite injections between January 2002 and May 2003; 8 patients were excluded from analysis because of missing data or inadequate follow-up time. Single-site phacotrabeculectomy was performed followed by subconjunctival antimetabolite injections of 5-fluorouracil (5-FU). Needling was performed as an office procedure if early evidence of subconjunctival scarring was observed 2-6 weeks after surgery. Additional subconjunctival 5-FU injections were administered after needling, and repeat needling was performed with 5-FU or mitomycin-C if subconjunctival scarring recurred. A complete success was defined as a reduction in intraocular pressure (IOP) to <18 mm Hg without the use of antiglaucoma medications or further surgical procedures to control IOP. The outcome was considered a qualified success when antiglaucoma medications were required to achieve the same result. RESULTS: The mean preoperative IOP was 21.9 (SD 6.3) mm Hg, and the mean postoperative IOP at 6 months was 13.0 (SD 6.7) mm Hg. The mean number of medications was reduced from 2.9 (SD 1.3) preoperatively to 0.5 (SD 0.9) postoperatively at 6 months. Needling was performed because of early evidence of subconjunctival scarring in 34 patients. The 6-month outcomes of 37 patients (64%) were a complete success and of 47 patients (81%) were a complete or qualified success. A longer follow-up of 10-23 months was attained in 25 of the 58 patients. At latest visit, the mean postoperative IOP of this group was 13.0 (SD 5.5) mm Hg, the mean number of postoperative medications was 0.7 (SD 1), and 21 of the 25 (84%) had achieved a complete or qualified success. The most common complication for all 58 patients was an early, self-limited postoperative wound leak that was unrelated to the needling intervention and was observed in 26 patients (45%). INTERPRETATION: Phacotrabeculectomy supplemented with early needle revision and antimetabolites may improve outcomes of combined cataract and glaucoma surgery.

Aged↗
PubMedDate not supplied

External dacryocystorhinostomy combined with mucosal grafting and magnetic resonance imaging.

PURPOSE: To facilitate understanding of the use of magnetic resonance imaging (MRI) in nasolacrimal obstructive diseases and to determine the indication for external dacryocystorhinostomy (DCR) combined with mucosal grafting. METHODS: We retrospectively studied the correlation between MRI images and surgical findings in 13 consecutive patients with swollen lacrimal sacs because of obstruction of the nasolacrimal duct or lacrimal sac. They were treated at the Kagoshima University Hospital between June 1999 and May 2001. RESULTS: A simple procedure of external DCR was performed in 9 cases, and a procedure combined with mucosal grafting was performed in 4 cases (age range, 51-88 years). Surgical findings in the fibrous region of the lacrimal sac corresponded to the hyperintense signal on MRI T(1)-weighted (T1W) images, more remarkably after enhancement. Surgical findings in the granulomatous sac and proteinaceous contents corresponded to the isointense areas on T2W images. Cases with thin sac were treated by standard DCR, whereas cases with thick, fibrous and granulomatous sac were treated by external DCR combined with mucosal grafting. CONCLUSIONS: The MRI images provide a useful preoperative determination for indications of external DCR combined with mucosal grafting.

Aged↗
PubMed1989

The venocutaneous fistula--a new approach to chronic venous access.

A surgical technique has been devised for creating access to the central venous circulation, yet avoiding a chronic, in-dwelling central venous catheter. While far removed from actual clinical application, the possibility of catheter-free access to the central venous circulation offers great potential for ease of care and a lessened infection rate of catheter-related sepsis.

Animals↗
PubMed2006

Laparoscopic pyelopyelostomy for retrocaval ureter without excision of the retrocaval segment: first report of 6 cases.

PURPOSE: We report our series of 6 cases of retrocaval ureter that were successfully treated with a laparoscopic approach. MATERIALS AND METHODS: Three men and 3 women with a mean age of 31 years (range 16 to 50) were referred to our department with a diagnosis of retrocaval ureter. One patient had a 12 mm renal pelvic calculus. A transperitoneal laparoscopic approach was used in all cases. The retrocaval segment along with some of the more proximal and distal segments of the ureter was readily mobilized. The distal part of the dilated renal pelvis was transected and the divided distal segment was repositioned to lie anterior to the inferior vena cava. The renal pelvic stone in 1 patient was readily removed at this point. Re-anastomosis was then performed over a Double-J stent placed intraoperatively using 2 rows of running 4-zero polyglactin sutures with intracorporeal knot tying. The stent was removed 4 weeks later. Excretory urography was performed 3 months after the laparoscopic procedure. RESULTS: Mean operative duration was 180 minutes (range 150 to 210). Patients were discharged home at a mean of 4 days (range 3 to 5). Followup excretory urogram 3 months after laparoscopic repair revealed a widely patent anastomosis with considerable improvement in hydronephrosis in all patients. CONCLUSIONS: To our knowledge this is the largest series of laparoscopic repair of retrocaval ureter reported to date. Laparoscopic pyelopyelostomy for retrocaval ureter without excision of the retrocaval segment is associated with an excellent outcome, minimal postoperative morbidity, short hospital stay and highly satisfactory cosmetic results.

Adolescent↗
PubMed1994

The gastric augment single pedicle tube catheterizable stoma: a useful adjunct to reconstruction of the urinary tract.

Since 1990 we have used stomach for bladder augmentation and continent urinary diversions in 73 patients, of whom 15 received a gastric tube catheterizable stoma and are the subject of this report. The gastric tube receives its blood supply from the same vascular pedicle as the gastric patch and, therefore, it can be moved anywhere along with the patch. The tube is then reimplanted in the reservoir or bladder following the Mitrofanoff principle and brought to the skin as a catheterizable stoma. Patient age ranged from 12 to 60 years. Three patients underwent augmentation cystoplasty and 12 received a composite gastrointestinal continent reservoir (in 10 a prior bowel conduit was detubularized and used as part of the reservoir). The appendix was either previously removed (10 patients) or not suitable as a catheterizable limb (4). All patients are continent. Catheters used to empty the reservoir varied from 12F to 18F. Complications included an early traumatic perforation of the tube in 1 patient, distal stenosis in 1 and mucosal redundancy in 1. Of these patients 2 required revision. Two patients had mild peristomal skin irritation without ulceration. Anatomical and technical aspects of this procedure are presented. In summary, we believe the gastric augment single pedicle tube to be a useful tool for the reconstructive urologist, which in select cases may obviate the need for additional bowel anastomosis to create a tapered intestinal catheterizable limb.

Adolescent↗
PubMed1994

Rescue of renal transplants with distal ureteral complications by pyelo-pyelostomy.

Secondary ureteroneocystostomy is the procedure most commonly used for repair of ureteral stenosis or necrosis in renal transplant patients. However, when the transplant ureter available for reconstruction is too short, ureteropyelostomy is the standard procedure. Another option is pyelo-pyelostomy, which has been used infrequently to date. Between 1979 and 1988 we managed 6 patients (4 men and 2 women 42 to 62 years old) with renal allografts who required repair of the transplant ureter for long segmented ureteral necrosis (3), long segmented ureteral stenosis (2) and an iatrogenic lesion of the ureter (1) with pyelo-pyelostomy. Of the 6 patients 2 had undergone previous rescue operations. Pyelo-pyelostomy with the renal pelvis of the graft was performed as first described by Gil-Vernet and Caralps in 1968. Median followup was 6 years (range 3 to 12 years). Two patients died of chronic rejection and pulmonary embolism, respectively. Four patients are still alive with functioning transplants and serum creatinine levels of less than 210 mumol/l. According to our experiences with 6 patients, we believe that pyelo-pyelostomy is a promising rescue maneuver that is worth consideration in cases of total or subtotal ureteral necrosis and long segmented ureteral stenosis after renal transplantation.

Adult↗
PubMed1990

A new technique for ileal nipple fixation: preliminary report.

A new technique for ileal nipple fixation is described in 6 post-cystectomy patients (4 with an ileal bladder substitute and 2 with an ileal reservoir) for the prevention of reflux. Nipple formation is helped by deperitonealization and defatting of the nipple mesentery. A full circumferential incision is made, except for the mesenteric border, and through both nipple layers down to the mucosa of the inner layer. The seromuscular layers on each side of the incision are closed together with continuous 3-zero polyglycolic acid suture. The overlying outer mucosa of both edges then is closed. Endoscopic and radiographic study 6 to 12 months postoperatively showed a stable nipple without reflux. The anatomical and physiological rationale of the technique is discussed.

Humans↗
PubMed1989

A new technique of using the in situ appendix as a catheterizable stoma in continent urinary reservoirs.

A new technique of using the in situ appendix to construct a continent catheterizable stoma is described in a patient who underwent continent urinary diversion, and the technical aspects of this procedure are illustrated in detail. The appendix is remodeled by invaginating its base into the cecum for 1 cm., cecoplicating the middle portion for 2 cm. and bringing the distal end to the skin as a cutaneous stoma. This new technique demonstrates that the in situ appendix can be constructed successfully to provide continence without the need for isolating it from the cecum and implanting the distal end into the urinary reservoir as described in the Mitrofanoff technique.

Adult↗