Surgery may be complicated by a persistent stapedial artery, fibrosis-related damage to the base of the bone, or obliterative otosclerosis, resulting in obliteration of the base.
Clinical relevance
Stapes
Stapes | Clinical relevance
Causes fibrosis-related damage to the base of the bone, or obliterative otosclerosis, resulting in obliteration of the base. There are risks of a perilymphatic gusher or a perilymph fistula along with risks of hearing damage. Surgery may be complicated by a persistent stapedial artery, fibrosis-related damage to the base of the bone, or obliterative otosclerosis, resulting in obliteration of the base Surgery may be complicated by a persistent stapedial artery, fibrosis-related damage to the base of the bone, or obliterative otosclerosis, resulting in obliteration of the base.
what are the 3 smallest bones in the human body
user
Strapes is one of them
assistant
what is the size of this above bone?
user
Roughly 3 x 2.5mm
assistant
which part of the body is this located?
user
Middle ear of humans
assistant
besides the human, is this bony structure present in other living species in the animal kingdom?
user
It is one of three ossicles in mammals, in non-mammalian four-legged animals its homologous form is called the columella
assistant
what are the functions this bony structure serves?
user
It transmits sound vibrations from the incus to the oval window, a membrane-covered opening to the inner ear.
assistant
are there any variations of this bony structure?
user
It appears to be relatively constant in size in different ethnic groups
assistant
can this bony structure get affected or impaired?
user
Yes, its impairment causes conductive hearing loss
assistant
is there any remedy to solve this?
user
Two common treatments are stapedectomy and stapedotomy
assistant
how is the first treatment that you mentioned - carried out?
user
It is the surgical removal of the stapes and replacement with an artificial prosthesis
assistant
what are some of the complications involved?
user
Surgery may be complicated by a persistent stapedial artery, fibrosis-related damage to the base of the bone, or obliterative otosclerosis, resulting in obliteration of the base.
Stapes | Clinical relevance
Complications of stapedectomy: When a stapedectomy is done in a middle ear with a congenitally fixed footplate, the results may be excellent but the risk of hearing damage is greater than when the stapes bone is removed and replaced (for otosclerosis). This is primarily due to the risk of additional anomalies being present in the congenitally abnormal ear. If high pressure within the fluid compartment that lies just below the stapes footplate exists, then a perilymphatic gusher may occur when the stapes is removed. Even without immediate complications during surgery, there is always concern of a perilymph fistula forming postoperatively.
Stapedectomy | Complications
The world's first stapedectomy is credited to Dr. John J.Shea Jr. who performed it in May 1956 on a 54-year-old housewife who could no longer hear even with a hearing aid. Significant contributions to modern stapedectomy techniques were then made by the late Dr. Antonio De La Cruz of the House Ear Institute in Los Angeles; by the late Professor Henri André Martin of the Hôpital Edouard Herriot in Lyon, France, including calibrated platinotomy (stapes footplate rather than whole surgery) and trans-footplate piston surgery that also paved the way for modern stapedotomy; and by the late Dr. Jean-René Causse of the eponymous clinic in Béziers, France, who pioneered the use of Teflon piston prostheses (also critical progress for stapedotomy) and, with his late son Dr.
Stapedectomy | History
Otosclerosis is a congenital or spontaneous-onset disease characterized by abnormal bone remodeling in the inner ear. Often this causes the stapes to adhere to the oval window, which impedes its ability to conduct sound, and is a cause of conductive hearing loss. Clinical otosclerosis is found in about 1% of people, although it is more common in forms that do not cause noticeable hearing loss. Otosclerosis is more likely in young age groups, and females. Two common treatments are stapedectomy, the surgical removal of the stapes and replacement with an artificial prosthesis, and stapedotomy, the creation of a small hole in the base of the stapes followed by the insertion of an artificial prosthesis into that hole.
Stapes | Clinical relevance
A modified stapes operation, called a stapedotomy, is thought by many otologic surgeons to be safer and reduce the chances of postoperative complications. In stapedotomy, instead of removing the whole stapes footplate, a tiny hole is made in the footplate - either with a microdrill or with a laser, and a prosthesis is placed to touch this area, oval window. This procedure can be further improved by the use of a tissue graft seal of the fenestra, which is now common practice. Laser stapedotomy is a well-established surgical technique for treating conductive hearing loss due to otosclerosis. The procedure creates a tiny opening in the stapes (the smallest bone in the human body) in which to secure a prosthetic.
Stapedectomy | Stapedotomy
In 1995, Glasscock et al. published a 25-year single-centre review of over 900 patients who underwent stapedectomy and stapedotomy and found complications rates as follows: reparative granuloma 1.3%, tympanic membrane perforation 1.0%, total sensorineural hearing loss 0.6%, partial sensorineural hearing loss 0.3%, and vertigo 0.3%. In this series, there was no incidence of facial nerve paralysis or tinnitus.
Stapedectomy | Complications
John Joseph Shea Jr. (September 4, 1924 – February 8, 2015) was an American medical doctor, professor and surgeon. He attended Christian Brothers High School, Memphis, Tennessee, the University of Notre Dame and Harvard Medical School. He performed the first successful reconstructive stapedectomy in May, 1956. The patient was a 54-year-old housewife with conductive hearing loss so severe that she could no longer hear at all, even with a hearing aid. Shea removed the stapes, covered the oval window opening with a vein graft removed from the back of the patient's hand, and inserted a prosthesis to replace the diseased stapes bone.
John J. Shea Jr. | Introduction
The stapes develops from the second pharyngeal arch during the sixth to eighth week of embryological life. The central cavity of the stapes, the obturator foramen, is due to the presence embryologically of the stapedial artery, which usually regresses in humans during normal development.
Stapes | Development
Occasionally the joints between the ossicles become rigid. One condition, otosclerosis, results in the fusing of the stapes to the oval window. This reduces hearing and may be treated surgically.
Ossicles | Clinical relevance
The stapes is commonly described as having been discovered by the professor Giovanni Filippo Ingrassia in 1546 at the University of Naples, although this remains the nature of some controversy, as Ingrassia's description was published posthumously in his 1603 anatomical commentary '. Spanish anatomist Pedro Jimeno is first to have been credited with a published description, in ' (1549). The bone is so-named because of its resemblance to a stirrup (), an example of a late Latin word, probably created in mediaeval times from "to stand" (), as stirrups did not exist in the early Latin-speaking world.
Stapes | History
If the periosteum or underlying muscles (frontalis, occipitalis, temporalis) are intact, secondary closure by granulation is possible. Before surgical intervention this was the only option available, as used to treat Robert McGee in 1864. Considering modern aesthetic standards, a better option is the use of split-thickness or full-thickness skin grafts, which is also quicker. When bulk is needed for a better contour a free flap is used, or as shown in the pictures, a regional flap.
Scalp reconstruction | Soft tissue defects
The results of this surgery are generally most reliable in patients whose stapes has lost mobility because of otosclerosis. Nine out of ten patients who undergo the procedure will come out with significantly improved hearing while less than 1% will experience worsened hearing acuity or deafness. Successful surgery usually provides an increase in hearing acuity of about 20 dB. That is as much difference as having your hands over both ears, or not. However, most of the published results of success fall within the speech frequency of 500 Hz, 1000 Hz and 2000 Hz; poorer results are typically obtained in the high frequencies, but these are normally less hampered by otosclerosis in the first place.
Stapedectomy | Introduction
A stapedectomy is a surgical procedure of the middle ear performed in order to improve hearing. If the stapes footplate is fixed in position, rather than being normally mobile, then a conductive hearing loss results. There are two major causes of stapes fixation. The first is a disease process of abnormal mineralization of the temporal bone called otosclerosis. The second is a congenital malformation of the stapes. In both of these situations, it is possible to improve hearing by removing the stapes bone and replacing it with a micro prosthesis - a stapedectomy, or creating a small hole in the fixed stapes footplate and inserting a tiny, piston-like prosthesis - a stapedotomy.
Stapedectomy | Introduction
Jean-Bernard Causse, the reattachment of the stapedius muscle alongside the use of veinous grafts.
Stapedectomy | History
The authors of the Earfold method point out that late complications, such as relapse, secondary deformations, defects, shifts in position or rejection of the implants, could only be assessed to a limited degree due to the short follow-up time of the patients in the study carried out (1,2).
EarFold | Surgical Procedure
A much more detailed description of the first two ossicles followed in Andreas Vesalius' "De humani corporis fabrica" in which he devoted a chapter to them. Vesalius was the first to compare the second element of the ossicles to an anvil although he offered the molar as an alternative comparison for its shape. The first published description of the stapes came in Pedro Jimeno's "Dialogus de re medica" (1549) although it had been previously described in public lectures by Giovanni Filippo Ingrassia at the University of Naples as early as 1546. The term "ossicle" derives from , a diminutive of "bone" (; genitive ).
Ossicles | History
The revival of the stapes mobilization operation by Rosen, in 1953, made the use of the microscope mandatory, although it was not used by the originators of the technique, Kessel (1878), Boucheron (1888) and Miot (1890). Mastoidectomies began to be performed with the surgical microscope and so were the tympanoplasty techniques that became known in the early 1950s. The stapes mobilization operation had varying results and was soon replaced by stapedectomy, first described by John Shea, Jr.; this was an operation that was always performed with the microscope. Today neurosurgeons are very proud to use microscopes in their procedures. But it was not always so: many prestigious centers did not accept that idea and it had to be developed in relative isolation.
Microsurgery | History
A small opening in the drape is then made overlying the incision and yellow hooks utilized to secure the edges of the opening to the edges of the incision, completely covering and isolating the patient's skin. At this point, new instruments and equipment are replaced and the entire prosthesis is inserted through the small opening of the loose drape. The loose drape allows for manipulation of the penis and scrotum required for this procedure without touching the skin.
Phalloplasty | Procedure
Because it is a simpler and safer procedure, stapedotomy is normally preferred to stapedectomy in the absence of predictable complications. However, the success rate of either surgery depends greatly on the skill and the familiarity with the procedure of the surgeon. Furthermore, a major success factor in both surgeries is correctly determining the length of the prosthesis.
Stapedectomy | Stapedectomy vs. stapedotomy
With extraordinary successes came certain risks and failures. The general risks of the surgery, in addition to standard risks of surgery, include permanent paralysis of the target muscle, recurrence of phantom limb pain, and development of painful neuromas. With the first patient, the ulnar nerve transfer was not successful. The muscle region was not reinnervated as expected, but instead turned bluish after mobilization, possibly due to a congestion of vascular supply. With the left-arm amputation woman mentioned above, her phantom limb pain returned after surgery. Though at a lesser degree and resolved within 4 weeks, it still presented a serious risk because it is unclear whether it will resolve in other future patients.
Targeted reinnervation | Risks and Complications
A downside to the procedure is that a permanent drainage path from the thoracic cavity is made and will need prolonged wound care and dressing changes. Complications can also include sepsis.
Eloesser flap | Complications
There are various methods to treat otosclerosis. However the method of choice is a procedure known as stapedectomy. Early attempts at hearing restoration via the simple freeing of the stapes from its sclerotic attachments to the oval window were met with temporary improvement in hearing, but the conductive hearing loss would almost always recur. A stapedectomy consists of removing a portion of the sclerotic stapes footplate and replacing it with an implant that is secured to the incus. This procedure restores continuity of ossicular movement and allows transmission of sound waves from the eardrum to the inner ear. A modern variant of this surgery called a stapedotomy, is performed by drilling a small hole in the stapes footplate with a micro-drill or a laser, and the insertion of a piston-like prothesis.
Otosclerosis | Surgery
Initial prototypes for the workhorses of surgical stapling, the TA and GIA staplers, were created by 1964.
Félicien M. Steichen | Lincoln Hospital: establishing the viability of surgical stapling
The team also wanted to discover whether this contamination occurred intermittently, or was persistent for those patients with 6 months of follow-up.
Cubicle curtain | Problems
In 1521, Berengario da Carpi performed the first surgical treatment for prolapse. This was to tie a rope around the prolapse, tighten it for two days until it was no longer viable and cut it off. Wine, aloe, and honey were then applied to the stump.
Vaginal anomalies | History
The first challenge to survival is assisted breathing and tubal feeding. This is a lifelong affair, generally requiring the patient to spend nearly all of the time under direct hospital care. American surgeons successfully used bone from the hip of an Irish teenager named Alan Doherty to rebuild a jaw and chin. Surgeons began the procedures in June 2007 and completed the final of seven surgeries on 25 August 2008. Doherty is now able to smile, but is still unable to breathe, eat, or speak on his own.
Otofacial syndrome | Treatment
The stapes appears to be relatively constant in size in different ethnic groups. In 0.01-0.02% of people, the stapedial artery does not regress, and persists in the central foramen. In this case, a pulsatile sound may be heard in the affected ear, or there may be no symptoms at all. Rarely, the stapes may be completely absent.
Stapes | Variation
Due to the spectrum of symptoms present within caudal duplication, there is no uniform surgical treatment in relieving symptoms. The type and severity of surgical intervention is often dependent upon the type and complexity of symptoms presented. Thus, the primary goal of surgical treatment for the syndrome is to relieve symptoms, not to restore normal anatomy, and hence, potentially life-threatening malformations are addressed first and often followed by other anatomic or aesthetic reconstructions in later stages. After the medical treatment, the patients are periodically monitored.
Caudal duplication | Spinal and lower limb tract
As Alfred Blalock and Helen Taussig wrote in "Journal of the American Medical Association", "Heretofore there has been no satisfactory treatment for pulmonary stenosis and pulmonary atresia. A “blue” baby with a malformed heart was considered beyond the reach of surgical aid. During the past three months we have operated on 3 children with severe degrees of pulmonary stenosis and each of the patients appears to be greatly benefited. In the second and third cases, in which there was deep persistent cyanosis, the cyanosis has greatly diminished or has disappeared and the general condition of the patients is proportionally improved." Following this report, and lectures given by Blalock and Taussig at conferences around Europe and America, the procedure quickly gained worldwide acceptance.
Helen B. Taussig | The first surgeries
The southern part of the redevelopment, which would have included a second tall block, was never constructed. The three remaining Victorian ward pavilion blocks were refurbished in the 1980s. They are now Grade II listed buildings. In November 1949, in an operating theatre in St Thomas' Hospital, Harold Ridley achieved the world's first implantation of an intraocular lens (IOL), treating a cataract in a 49-year-old female patient. In later life Ridley himself underwent successful bilateral intraocular lens implantation at St Thomas's. What was most pleasing to him was that he had the operation done in the same hospital where he had performed the first operation in 1949.
St Thomas' Hospital | Post-war rebuilding
Surgical treatment involves resection of the stenosed segment and re-anastomosis. Two complications specific to this surgery are left recurrent nerve palsy and chylothorax, as the recurrent laryngeal nerve and thoracic duct are in the vicinity. Chylothorax is a troublesome complication and is usually managed conservatively by adjusting the diet to eliminate long-chain fatty acids and supplementing medium-chain triglycerides. When conservative management fails surgical intervention is then most often required. Fluorescein dye can aid in the localisation of chyle leak.
Coarctation of the aorta | Complications of surgery
The treatment for Bonnet–Dechaume–Blanc syndrome is controversial due to a lack of consensus on the different therapeutic procedures for treating arteriovenous malformations. The first successful treatment was performed by Morgan et al., who combined intracranial resection, ligation of the ophthalmic artery, and selective arterial ligature of the external carotid artery. Notably, the patient did not have retinal vascular malformations. Lesions are watched closely for changes in size. Prognosis is best when lesions are less than 3 cm in length. Most complications occur when the lesions are greater than 6 cm in size. Surgical intervention for intracranial lesions has been done successfully.
Bonnet–Dechaume–Blanc syndrome | Treatment
Comparisons have shown stapedotomy to yield either as good or better results than stapedectomy (measured by hearing improvement and reduction in the air-bone hearing gap, and especially at higher sound frequencies), and to be less prone to complications. In particular, stapedotomy procedure greatly reduces the chance of a perilymph fistula (leakage of cochlear fluid). Stapedotomy, like stapedectomy, can be successful in the presence of sclerotic adhesions (tissue growths abnormally linking the bones to the tympanic cavity), provided the adhesions are removed during surgery. However, the adhesions may recur over time. The stapedotomy method is not applicable in those relatively rare cases that involve scleroris of the entire ossicular chain.
Stapedectomy | Stapedectomy vs. stapedotomy
Burou made a point of barring, but not damaging, the posterior aspect of the prostate so that the penile skin flap after invagination would immediately overlie this aspect, which he felt optimized the possibility of postoperative orgasm. The separation was extended digitally and was considered complete as soon as two fingers or a vaginal retractor could be admitted easily. Burou considered this first part of the operation to be the most important, but most risky, and stressed the importance of repeated intrarectal inspection to determine that there was no lesion to the rectal wall. He considered the second part of the operation to be relatively easy.
Georges Burou | Burou's vaginoplasty procedure
Since this lesion is usually a complication of long standing otitis media, it is important to use an appropriate antibiotic therapy regimen. If the patient fails first line antibiotics, then second-line therapies should be employed, especially after appropriate culture and sensitivity testing. Surgery may be required if there is extension into the mastoid bone, or if a concurrent cholesteatoma is identified during surgery or biopsy. In general, patients have an excellent outcome after appropriate therapy.
Otic polyp | Management
An initial pocket is created under the conjunctiva and Tenon's capsule and the wound bed is treated for several seconds to minutes with mitomycin C (MMC, 0.5–0.2 mg/ml) or 5-fluorouracil (5-FU, 50 mg/ml) soaked sponges. These chemotherapeutics help to prevent failure of the filter bleb from scarring by inhibiting fibroblast proliferation. Alternatively, non-chemotherapeutic adjuvants can be implemented to prevent super scarring by wound modulation, such as the ologen collagen matrix implant. Some surgeons prefer "fornix-based" conjunctival incisions while others use "limbus-based" construction at the corneoscleral junction which may allow easier access in eyes with deep sulci. A partial thickness flap with its base at the corneoscleral junction is then made in the sclera after careful cauterization of the flap area, and a window opening is created under the flap with a Kelly-punch to remove a portion of the sclera, Schlemm's canal and the trabecular meshwork to enter the anterior chamber.
Trabeculectomy | Procedure
Sterile drapes are placed around the operative site. Surgical masks are worn by the surgical team to avoid germs on droplets of liquid from their mouths and noses from contaminating the operative site. Work to correct the problem in body then proceeds. This work may involve:
Surgery | Intraoperative phase
The first membranes developed were nonresorbable and required a second surgery for membrane removal some weeks later. The need for a second surgical procedure hindered the utilization of the original barrier membranes, which led to the development of resorbable membranes; research indicates no statistically significant difference in surgical success between the two types.
Barrier membrane | Origins
Because of the experimental character of this surgery some chose to remain as they were and others could just not be helped yet. Some of the latter were helped by all kinds of new prosthetics to make them look more or less 'normal'.
Gueules cassées | Background
For patients with strabismus, risks of complications such as diplopia and/or increased strabismus angle need to be evaluated carefully. In case both refractive surgery and strabismus surgery are to be performed, it is recommended that the refractive surgery be done first.
Refractive surgery | Risks
The antibiotic, streptomycin was discovered in the U.S.A. in 1942. It enabled previously ill patients to be made fit for surgery. The first patient to receive streptomycin in Scotland, was author and journalist, George Orwell. Orwell was admitted to Hairmyres on Christmas Eve 1946. At the time of his admission he was writing his novel Nineteen Eighty-Four. The staff, insisting that complete physical and mental rest was essential for effective treatment, confiscated his typewriter. With rest, his health improved to some extent but attempts to rest his badly affected lung by simple surgical procedures were not successful. He suffered severe side effects from his treatment, and although the disease was responding, it had to be stopped after fifty days.
University Hospital Hairmyres | Second World War
Bleeding is the most common postoperative complication. Severe postoperative pain could be caused by dehiscence of the anastomosis or due to the fact that the anastomosis is too near to the linea dentata. A rare complication stemming from PPH is intra-abdominal bleeding.
Stapled hemorrhoidopexy | Short-term complications
Intraoperatively, bubble related problems can happen in early learning curve. This can be managed by proper positioning of needle and controlled intrabubble pressure. Postoperative graft detachment can happen in eyes with insufficient air or loss of air after surgery.1,6 If the graft is detached in the centre and there is significant cornea edema, immediate graft repositioning by air is performed in operating theatre under sterile precautions.
Pre-Descemet's Endothelial Keratoplasty | Complications
There is also an increased risk of hemorrhage and infection secondary to the surgical procedure.
Hypophysectomy | Complications
For patients with severe pectus carinatum, surgery may be necessary. However bracing could and may still be the first line of treatment. Some severe cases treated with bracing may result in just enough improvement that patient is happy with the outcome and may not want surgery afterwards. If bracing should fail for whatever reason then surgery would be the next step. The two most common procedures are the Ravitch technique and the Reverse Nuss procedure. A modified Ravitch technique uses bioabsorbable material and postoperative bracing, and in some cases a diced rib cartilage graft technique.
Pectus carinatum | Surgical
In late 1958, Steichen, Ravitch, and Ravitch's then-current Chief Resident, Peter Weil, began laboratory experiments with stapling instruments. The staplers they used had been procured by Mark Ravitch in Moscow during a medical experts' visit to the Soviet Union earlier in 1958 that was unrelated to stapling. In early 1959, the BCH team began to use the staplers clinically. In 139 pulmonary lobectomies and segmentectomies for tuberculosis through 1961, the BCH team showed a significant reduction in life-threatening complication of bronchial fistula, from 14% using manual closures to 4.6% using staplers. This work was published in the "Journal of Thoracic and Cardiovascular Surgery," Steichen's first appearance as a major author of a scientific paper.
Félicien M. Steichen | Baltimore City Hospital
This often requires surgical intervention to prevent the progression of arthris. Two commonly performed procedures are: 1. Proximal row carpectomy (PRC), which involves removing the first row of the carpal bones, i.e. the scaphoid, lunate and triquetrum. The wrist is immobilised in a cast for six weeks after the surgery and then physiotherapy is started. 2. Scaphoid excision and 4-corner fusion, which is a procedure consisting of the removal of the scaphoid and fixation of the remaining wrist bones with a plate (called a "spider plate") or wires in order to provide stability. The plate usually is left inside the patient's wrist, while the wires (usually K-wires) have to be removed in a second surgery.
Preiser disease | Introduction
All those definitions are descriptive, but morphologically vacuous. In contrast, a professional botanical publication puts the matter plainly in a key to "Eriogonum": "Scapes (the first internode)... Botanically, any such structure is practically of necessity an internode".
Scape (botany) | Practical definition
After the surgery, some patients require intubation and mechanical ventilation for several days to allow adequate tracheal toilet, but most patients can have the tubes removed soon after the surgery. The obstructive airway symptoms may be worse in the first postoperative weeks. Only a few patients have immediate relief of stridor, but many obtain immediate relief of problems with swallowing (dysphagia). After extubation, it might be necessary to maintain positive airway pressure by appropriate flows of a humidified oxygen/air mixture.
Double aortic arch | Postoperative care
Many long-term complications have been described. Most of them are related to either an incorrect indication for surgery or technical errors. Several authors stated that although it seems to be an easy operation to perform, it should only be done by experienced surgeons. Severe complications leading to death have been described but are rare. Irreversible urge incontinence due to lesions of the sphincter muscle or a diminished rectal capacity due to resection of too much mucosa, are quite common complications if the procedure is not performed properly. Rectovaginal fistulas and anastomotic diverticula are very rare but possible.
Stapled hemorrhoidopexy | Long-term complications
In clinical situations the antibiotic sensitivity can be obtained through disk diffusion assays of E-strip test. Treatment of clinical cases, such as the outbreak at the Hospital Joan March, were treated case by case, based on the antibiogram obtained from each patient's sputum sample. More broadly, prevention of initial infection, particularly in a hospital setting, is a key element of treatment. Sterilising all surfaces, and prostheses, as well as constant replacement and maintenance of prosthesis, is an integral element of stopping disease establishment.
Corynebacterium striatum | Treatment
The initial puncture is with a sharp instrument, and this may lead to hemorrhage or perforation of the organ in question. Infection is a possible complication, and hence asepsis is practiced during most Seldinger procedures. Loss of the guidewire into the cavity or blood vessel is a significant and generally preventable complication.
Seldinger technique | Complications
The flap is incised and elevated over the periosteum from distal to proximal. The flap consists of skin, subcutaneous tissue, fat and frontalis muscle and is not thinned. When reaching the brow, all of the skin borders are incised and the flap is carefully released. The full-thickness flap is then sutured into the defect without tension.
Nasal reconstruction using a paramedian forehead flap | First stage
Surgery Surgical intervention is warranted in patients who present with new onset neurological signs and symptoms or have a history of progressive neurological manifestations which can be related to this abnormality. The surgical procedure required for the effective treatment of diastematomyelia includes decompression (surgery) of neural elements and removal of bony spur. This may be accomplished with or without resection and repair of the duplicated dural sacs. Resection and repair of the duplicated dural sacs is preferred since the dural abnormality may partly contribute to the "tethering" process responsible for the symptoms of this condition. Post-myelographic CT scanning provides individualized detailed maps that enable surgical treatment of cervical diastematomyelia, first performed in 1983.
Diastematomyelia | Treatment
The first surgical approach consists of resection and primary anastomosis. This first stage of surgery is performed on people if they have a well-vascularized, nonedematous and tension-free bowel. The proximal margin should be an area of pliable colon without hypertrophy or inflammation. The distal margin should extend to the upper third of the rectum where the taenia coalesces. Not all of the diverticula-bearing colon must be removed, since diverticula proximal to the descending or sigmoid colon are unlikely to result in further symptoms.
Diverticulitis | Technique
If the mobility of the stapes is reduced due to otosclerosis, then stapedius muscle contraction does not significantly decrease the admittance. When acoustic reflex testing is conducted, the acoustic reflex thresholds (ART) cannot be determined when attempting to measure on the affected side. Also, a conductive pathology will attenuate the test stimuli, resulting in either elevated reflex thresholds or absent reflexes when the stimulus is presented in the affected ear and measured in the other ear.
Otosclerosis | Audiometry
Wilson-MacDonald argues that oral antibiotics are "inadequate", and recommends intravenous antibiotics for managing the infection. Some authors suggest surgical irrigation of the bursa by means of a subcutaneous tube. Others suggest that bursectomy may be necessary for intractable cases; the operation is an outpatient procedure that can be performed in less than half an hour.
Prepatellar bursitis | Treatment
After obtaining the informed consent from the patient, local anesthesia is given. Anterior chamber entry (eye entry) is made by a blade in the superior corneo-limbus area. Descemet's membrane along with endothelium in the patient is removed mechanically by reverse Sinskey hook by controlled stripping on the endothelial side (Fig 3A-C).
Pre-Descemet's Endothelial Keratoplasty | Host Bed Preparation
Treatment consists of surgery for widening the nostrils, removing the excess tissue of an elongated soft palate, or removing everted laryngeal saccules. Early treatment prevents secondary conditions from developing. Potential complications include hemorrhages, pain, and inflammation during and after surgery. Some veterinarians are hesitant to perform soft palate correction surgery. With CO surgical lasers, these complications are greatly diminished.
Brachycephalic airway obstructive syndrome | Treatment
This procedure was first described by an Italian surgeon – Dr. Antonio Longo, Department of Surgery, University of Palermo – in 1993 and since then has been widely adopted through Europe. This procedure avoids the need for wounds in the sensitive perianal area and, as a result, has the advantage of significantly reducing the patient's post operative pain. Follow-up on relief of symptoms indicate a similar success rate to that achieved by conventional haemorrhoidectomy. Since PPH was first introduced it has been the subject of numerous clinical trials and in 2003 the National Institute of Clinical Evidence (NICE) in the UK issued full guidance on the procedure stating it was safe and efficacious.
Stapled hemorrhoidopexy | Development
Then the graft is attached to the overlying host stroma pneumatically (Fig 3E,F). Air fluid pressure is maintained inside the chamber for 60 seconds and then minimal air is released. The wound is closed with 10-0 monofilament suture and subconjunctival antibiotic steroid injection is given.
Pre-Descemet's Endothelial Keratoplasty | Graft Injection into Host Bed
The disease can be treated with external in-situ pinning or open reduction and pinning. Consultation with an orthopaedic surgeon is necessary to repair this problem. Pinning the unaffected side prophylactically is not recommended for most patients, but may be appropriate if a second SCFE is very likely. Once SCFE is suspected, the patient should be non-weight bearing and remain on strict bed rest. In severe cases, after enough rest the patient may require physical therapy to regain strength and movement back to the leg. A SCFE is an orthopaedic emergency, as further slippage may result in occlusion of the blood supply and avascular necrosis (risk of 25 percent).
Slipped capital femoral epiphysis | Treatment
Ideally this procedure can be performed near the midline of the brain with minimal side-to-side motions of the endoscope so as to not tear tissues and cause further complications. Research has found that this procedure has a 75% success rate, that 72% of ETV surgeries are still correctly functioning after 15 years, and that patients have shorter hospital stays recovering as compared to shunting. If the procedure does not successfully cure the aqueductal stenosis, a second surgery can be performed to enlarge the incision or implant a shunt. Problems that can lead to these failures and require additional surgery include the stoma becoming closed or a new membrane forming across the stoma over time.
Aqueductal stenosis | Endoscopic third ventriculostomy
Tumour ingrowth or overgrowth can be additionally palliated by the placement of a second stent through the lumen of the first, through electrocautery or argon plasma coagulation of the tumour tissue in the stent, or through the use of photodynamic therapy. Over time, SEMS may also migrate to a different position that does not help with treatment of the obstructed area. This may be treated with placement of a second SEMS, or endoscopic attempts to reposition or remove the first. Rarely, SEMS may fracture or intussescept after endoscopic intervention.
Self-expandable metallic stent | Complications
Subsequently, all erectile bodies were pushed out and dissected from the penile skin. When available, the foreskin was kept and the distal, coronal edge of the penile skin was closed; this yielded the skin tube that was inserted as neovaginal lining.
Georges Burou | Burou's vaginoplasty procedure
This enabled the surgeons to be more precise in treating the mitral valve and not have the balloon to slip out of place; the wire served as a guide to inserting the balloon. Other Percutaneous procedures beside balloon valvuloplasty for MS have been looked into. Percutaneous Leaflet Plication (Edge-to-Edge Leaflet Repair) is being explored as a way to increase the opening of the mitral valve by clamping down mitral leaflets. The clamps are delivered to the mitral through a catheter as with the balloon, and then clamped onto the mitral valve. Of the patients that received this treatment, 74% patients achieved surgical success, and at 1-year, 68% were saved from dying, 90% from having to have surgery or dying from the lack thereof, a 76.3% prognosis at three years.
Lutembacher's syndrome | Recent research
This will avoid any problems to the distal circulation in the limb, which may already be compromised. Lymphedema, when present, will significantly improve within a few weeks of the first surgery.” For the direct closure of the defect after dissecting a constriction band there are two different techniques:
Constriction ring syndrome | Surgical technique
Follow-up studies by Levy et al. and Stannard at al. both examined failure rates for posterolateral corner repairs and reconstructions. Failure rates repairs were approximately 37 – 41% while reconstructions had a failure rate of 9%. Other less common surgical complications include deep vein thrombosis (DVTs), infection, blood loss, and nerve/artery damage. The best way to avoid these complications is to preemptively treat them. DVTs are typically treated prophylactically with either aspirin or sequential compression devices (SCDs). In high risk patients there may be a need for prophylactic administration of low molecular weight heparin (LMWH). In addition, having a patient get out of bed and ambulate soon after surgery is a time honored way to prevent DVTs.
Posterolateral corner injuries | Complications
However, the installation of a free-flap has been shown to significantly reduce the risks of PCF. Other complications such as wound infection, dehiscence and necrosis, bleeding, pharyngeal and stomal stenosis, and dysphagia have also been reported in fewer cases.
Laryngectomy | Complications
The treatment of choice is a large resection or amputation of the affected limb. Radiation therapy can precede or follow surgical treatment. Tumors that have advanced locally or have metastasized can be treated with mono or polychemotherapy, systemically or locally. However, chemotherapy and radiation therapy have not been shown to improve survivorship significantly. In cases of upper limbs, forequarter amputation (disarticulation of upperlimb along with clavicle and scapula) is preferred.
Stewart–Treves syndrome | Treatment
Moseley and coworkers studied the effect of arthroscopic surgery for osteoarthritis of the knee establishing two treatment groups and a sham-operated control group. They found that patients in the treatment arms did no better than those in the control group. The fact that all three groups improved equally points to the placebo effect in surgical interventions. In a recent study it was found, that arthroscopic partial meniscectomy does not offer any benefit over sham (or fake) surgery in relieving symptoms of knee locking or catching in patients with degenerative meniscal tears. A randomised controlled trial was carried out to investigate the effectiveness of shoulder surgery to remove an acromial spur (bony protuberance on x-ray) in patients with shoulder pain.
Sham surgery | Orthopedic diseases
Complications associated with the surgical procedure include; reaction to anaesthesia, excessive bleeding, injury to other organs, and infection. One study also confirmed after reviewing 21,000 procedures, that there was no increased risk in hysterectomy plus bilateral salpingectomy compared to hysterectomy alone. This may indicate that there are no surgical risks related to salpingectomy alone. They also found that prophylactic salpingectomy did not increase length of stay or the likelihood of readmission or blood transfusion. This is a reassuring and highly interesting result as both of these complications were voiced as surgical concerns at the time prophylactic salpingectomy was first proposed.
Prophylactic salpingectomy | Surgical risks
The first stage of treatment used to be a reversible colostomy. In this approach, the healthy end of the large intestine is cut and attached to an opening created on the front of the abdomen. The contents of the bowel are discharged through the hole in the abdomen and into a bag. Later, when the patient's weight, age, and condition are right, the "new" functional end of the bowel is connected with the anus. The first surgical treatment involving surgical resection followed by reanastomosis without a colostomy occurred as early as 1933 by Doctor Baird in Birmingham on a one-year-old boy.
Hirschsprung's disease | Colostomy
After the procedure was complete, the eye was then washed with salt water and then bandaged with cotton wool soaked in oil of roses and egg whites. After the operation, there was concern that the cataract, once it had been pushed to one side, would reascend, which is why patients were instructed to lie on his or her back for several days following the surgery.
Medicine in the medieval Islamic world | Treatment
Surgery was important in treating patients with eye complications, such as trachoma and cataracts. A common complication of trachoma patients is the vascularization of the tissue that invades the cornea of the eye, which was thought to be the cause of the disease, by ancient Islamic physicians. The technique used to correct this complication was done surgically and known today as peritomy. This procedure was done by "employing an instrument for keeping the eye open during surgery, a number of very small hooks for lifting, and a very thin scalpel for excision." A similar technique in treating complications of trachoma, called pterygium, was used to remove the triangular-shaped part of the bulbar conjunctiva onto the cornea.
Medicine in the medieval Islamic world | Treatment
Because of the risk of secondary infection, it is crucial that tympany be treated as soon as possible. Treatment protocols may include, but are not limited to, surgical intervention and in cases where surgery is not an option, insertion of a transnasal Foley balloon catheter in an attempt to remodel the pharyngeal orifice.
Guttural pouch | Guttural Pouch Tympany
In some patients a new tumor develops in the skin injured by the sun or an old cancer can redevelop. In a few cases the result of the first reconstruction was not good enough. When this takes place the next step is to take away the old flap and redo the reconstruction. A second flap can be taken from the contra lateral side in most instances
Nasal reconstruction using a paramedian forehead flap | Recurrence/ inadequate initial reconstruction
Additionally, surgery was unsuccessful with a patient because severe nerve injuries were not detectable until during the surgery.
Targeted reinnervation | Risks and Complications
One treatment of last resort is presacral neurectomy.
Dysmenorrhea | Surgery
His initial attempts in dogs were unsuccessful and all experimental animals died within a few hours; however, despite these failures, he successfully performed this operation in a young woman with tricuspid atresia in 1968 with Dr Eugene Baudet. The operation was completed on a second patient in 1970, and after a third case the series was published in the international journal "Thorax" in 1971. Dr. Guillermo Kreutzer from Buenos Aires, Argentina (b. 1934) without any knowledge of Fontan's experience performed a similar procedure in july, 1971 without placing a valve in the Inferior Vena Cava inlet and introducing the concept of "fenestration" leaving a small atrial septal defect to serve as a pop-off valve for the circulation.
Fontan procedure | History
In 1946, he wrote a paper for the first issue of "Thorax" on spontaneous rupture of the oesophagus (Boerhaave syndrome), in which he commented that ""in the byways of surgery there can be few conditions more dramatic in their presentation and more terrible in their symptoms than spontaneous perforation of the oesophagus. No case has yet been treated successfully, and diagnosis has only been achieved in a very few before death"". A year later, on 7 March 1947, he performed the first successful repair of a ruptured oesophagus.
Norman Barrett | Career
In cases when all conservative treatment fails, surgical therapy may be necessary. In a bursectomy the bursa is cut out either endoscopically or with open surgery. The bursa grows back in place after a couple of weeks but without any inflammatory component.
Bursitis | Treatment
As with almost every kind of surgery, the main complications in both treatments of hypertelorism include excessive bleeding, risk of infection and CSF leaks and dural fistulas. Infections and leaks can be prevented by giving perioperative antibiotics and identifying and closing of any dural tears. The risk of significant bleeding can be prevented by meticulous technique and blood loss is compensated by transfusions. Blood loss can also be reduced by giving hypotensive anesthesia. Rarely major eye injuries, including blindness, are seen. Visual disturbances can occur due to the eye muscle imbalance after orbital mobilization. Ptosis and diplopia can also occur postoperatively, but this usually self-corrects.
Hypertelorism | Complications from surgery
PPH employs a unique circular stapler which reduces the degree of prolapse by excising a circumferential strip of mucosa from the proximal anal canal. This has the effect of pulling the hemorrhoidal cushions back up into their normal anatomical position. Usually, the patient will be under general anesthetic, but only for 20–30 minutes. Many cases have been successfully performed under local or regional anesthesia and the procedure is suited to day case treatment.
Stapled hemorrhoidopexy | Procedure
German psychiatrist Lothar Kalinowsky had witnessed ECT in Italy and demonstrated it at the Burden Neurological Institute; five patients at Barnwood House were selected as guinea pigs for the new form of convulsive therapy. "We selected five psychotics for treatment at Barnwood House. Altogether 75 shocks have been administered, as a result of which there have been 50 major convulsions and 25 minor attacks. There have been no unpleasant sequelae, and none of the patients has refused further treatments. This small preliminary series was not intended to provide data on the therapeutic value of the treatment – in only one of the patients could a remission be hoped for with any confidence – but was designed to throw light on the relative advantages and dangers of the method." The advantages were immediately apparent: "For the operator, only a small amount of training and experience is necessary, and a knowledge of physics, though desirable on general grounds, is not essential….the apparatus is comparatively cheap and portable, and preparation of the patient need take no more than a minute." Four certified patients at Barnwood House were also amongst the first in England to undergo prefrontal leucotomy, again as a result of a collaboration between Barnwood and the Burden Neurological Institute.
Barnwood House Hospital | "All the most modern methods of treatment"
Infection is typically controlled by administering 1 gram of the antibiotic cefazolin (Ancef) prior to surgery. Excessive blood loss and nerve/artery damage are rare occurrences in surgery and can usually be avoided with proper technique and diligence; however, the patient should be warned of these potential complications, especially in patients with severe injuries and scarring.
Posterolateral corner injuries | Complications
The first line treatment for patients with thoracic aortic injury is maintaining the patient's airway with intubation and treating secondary injuries such as a hemothorax. After ensuring the patient has a patent airway and other life-threatening injuries are treated then treatment for the aortic injury can be started. Due to the constant risk of sudden rupture or exsanguination urgent treatment is necessary. A patient can either undergo endovascular repair or surgical repair. Endovascular repair is the current gold standard due to increased success rates and lower complications. Patients that are able to undergo endovascular repair without contraindications should proceed with it.
Thoracic aorta injury | Treatment
The most common cause for the fecal incontinence was obstetric procedures, idiopathic origin and prior anal surgery, and all these people were refractory to the conservative treatment. The procedure consisted of placing a temporary pulse generator connected to a unilateral electrode at S3 or S4 foramen for 2–4 weeks. After it was confirmed that the SNS was decreasing the incontinence episodes, the patients received the definitive electrode and pulse generator that was implanted in the gluteus or in the abdomen. Two patients did not show improvement in the first step and did not receive the definitive stimulator. Mean follow up was 17.02 months and during this time the patients showed improvement in the voluntary contraction pressure and reduction of incontinence episodes.
Sacral nerve stimulation | Fecal incontinence
Surgical approaches have also been used successfully in TOS. Microsurgery can be used approaching the area from above the collar bone (supraclavicular) followed by neurolysis of the brachial plexus, removal of the scalene muscle (scalenectomy), and the release of the underlying (subclavicular) blood vessels. This approach avoids the use of resection, and has been found to be an effective treatment. In cases where the first rib (or a fibrous band extending from the first rib) is compressing a vein, artery, or the nerve bundle, part of the first rib and any compressive fibrous tissue, can be removed in a first rib resection and thoracic outlet decompression surgical procedure; scalene muscles may also need to be removed (scalenectomy).
Thoracic outlet syndrome | Surgery
The first issue of clinical concern in the setting of stridor is whether or not tracheal intubation or tracheostomy is immediately necessary. A reduction in oxygen saturation is considered a late sign of airway obstruction, particularly in a child with healthy lungs and normal gas exchange. Some patients will need immediate tracheal intubation. If intubation can be delayed for a period, a number of other potential options can be considered, depending on the severity of the situation and other clinical details. These include: In obese patients elevation of the panniculus has shown to relieve symptoms by 80%.
Stridor | Treatments
All "in situ" devices are based upon steel circumcision rings originally patented by Cecil Ross in 1939. Plastibell represents the first commercialization of the Ross device and is the progenitor of all subsequent "in situ" devices. Such devices consist of a plastic ring which is inserted beneath the foreskin at the level of the corona and has a ligature (or ligature device) which acts as a tourniquet. This necroses the remaining part of the foreskin and the device either detaches spontaneously after 4 to 7 days, or is removed surgically at one week. Initial implementation of "in situ" devices for HIV prevention has failed to demonstrate potential advantages with regard to efficiency or cost, compared to conventional surgical circumcision.
Circumcision surgical procedure | Circumcision "in situ" devices
The drapes were hung in straight panels from the carved and gilded 1902 wooden cornices. The design of the valances was not finalized until April 1964. First Lady Lady Bird Johnson asked Jacqueline Kennedy to assist her in finalizing the design. Originally, they were to be of brocatelle, a jacquard weave fabric similar to brocade but thicker and heavier and with designs in high relief. But this design was countermanded by Boudin. Instead, gold lampas, trimmed with braid and hemmed with gilt, spun-metal twisted fringe at the bottom, was installed in flat panels from behind each cornice. The curtains and valances took nearly three years to design and manufacture, and were not hung in the room until the Johnson administration in 1965.
East Room | Kennedy refurbishment
A wide range of treatments are possible, including rest, surgery and casting.
Trapezoid bone | Clinical Significance
The morphology of the stapes suggests that the animal was capable of hearing high-frequency sound. "B. woodi" does not possess lateral line sulci or an ossified branchial system. The principal method of respiration was probably buccal (gulping air through mouth) rather than costal (expanding chest volume to take in air), indicated by the small straight ribs.
Balanerpeton | Introduction
For those with suprasellar arachnoid cysts, it has been discovered that endoscopic ventriculocystocisternostomy is the optimal treatment option. By fenestrating, or opening, the cystic membrane and removing the fluid, all obstructions of the aqueduct were resolved. In patients receiving this treatment, a full recovery is the most common result.
Bobble-head doll syndrome | Endoscopic ventriculocystocisternostomy
The condition may be treated with stretching exercises and steroid creams. It also may be treated with surgery. There are several different techniques to treat this condition. Threading a suture through the lower membrane, and then tying a tight knot around the frenulum itself is a procedure that minimises invasive action. After a few days the frenulum will weaken and eventually break apart to allow the prepuce to fully retract. Other procedures involve the cutting of the skin and require the use of sutures to help in the healing process. Alternatively, it may be treated by a reparative plastic surgery operation called a frenuloplasty, or by complete circumcision including resection of the frenulum (frenectomy).
Frenulum breve | Treatment
A quite difficult problem to correct postoperatively is canthal drift, which can be managed best by carefully preserving the canthal tendon attachments as much as possible. Despite the extensiveness in these procedures, mortality is rarely seen in operative correction of hypertelorism.
Hypertelorism | Complications from surgery
About 9 months later, the first complete cranium replacement with a 3D-printed plastic insert was performed on a Dutch woman. She had been suffering from hyperostosis, which increased the thickness of her skull and compressed her brain.
Skull | Injuries and treatment
PPH is generally indicated for the more severe cases of internal hemorrhoidal prolapse (3rd and 4th degree) where surgery would normally be indicated. It may also be indicated for patients with minor degree haemorrhoids who have failed to respond to conservative treatments. The procedure may be contra-indicated when only one cushion is prolapsed or in severe cases of fibrotic piles which cannot be physically repositioned. In addition to correcting the symptoms associated with the prolapse, problems with bleeding from the piles are also resolved by this excision. Although the cushions may be totally or partially preserved, the blood supply is interrupted or venous drainage is improved by the repositioning.
Stapled hemorrhoidopexy | Indications
The initial incision was extended along the raphe of the scrotum to the root of the penis. The surgical field was widened by retracting the scrotal skin on both sides and widely exposing the corpus spongiosum, both corpora cavernosa, and the two testes. Once the testes and their pedicles had been dissected, the spermatic cord was cut and ligated. Then, both corpora cavernosa were ligated and cut at a level just distally to their attachment to the inferior ramus of the pubic bone. The level of transection of the spongious bulb and urethra had to correspond with the length of the future urethra.
Georges Burou | Burou's vaginoplasty procedure