• Title/Summary/Keyword: Surgical success

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Cut-off Value for Body Mass Index in Predicting Surgical Success in Patients with Lumbar Spinal Canal Stenosis

  • Azimi, Parisa;Yazdanian, Taravat;Shahzadi, Sohrab;Benzel, Edward C.;Azhari, Shirzad;Aghaei, Hossein Nayeb;Montazeri, Ali
    • Asian Spine Journal
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    • v.12 no.6
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    • pp.1085-1091
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    • 2018
  • Study Design: Case-control. Purpose: To determine optimal cut-off value for body mass index (BMI) in predicting surgical success in patients with lumbar spinal canal stenosis (LSCS). Overview of Literature: BMI is an essential variable in the assessment of patients with LSCS. Methods: We conducted a prospective study with obese and non-obese LSCS surgical patients and analyzed data on age, sex, duration of symptoms, walking distance, morphologic grade of stenosis, BMI, postoperative complications, and functional disability. Obesity was defined as BMI of ${\geq}30kg/m^2$. Patients completed the Oswestry Disability Index (ODI) questionnaire before surgery and 2 years after surgery. Surgical success was defined as ${\geq}30%$ improvement from the baseline ODI score. Receiver operating characteristic (ROC) analysis was used to estimate the optimal cut-off values of BMI to predict surgical success. In addition, correlation was assessed between BMI and stenosis grade based on morphology as defined by Schizas and colleague in total, 189 patients were eligible to enter the study. Results: Mean age of patients was $61.5{\pm}9.6years$. Mean follow-up was $36{\pm}12months$. Most patients (88.4%) were classified with grades C (severe stenosis) and D (extreme stenosis). Post-surgical success was 85.7% at the 2-year follow-up. A weak correlation was observed between morphologic grade of stenosis and BMI. Rates of postoperative complications were similar between patients who were obese and those who were non-obese. Both cohorts had similar degree of improvement in the ODI at the 2-year followup. However, patients who were non-obese presented significantly higher surgical success than those who were obese. In ROC curve analysis, a cut-off value of ${\leq}29.1kg/m^2$ for BMI in patients with LSCS was suggestive of surgical success, with 81.1% sensitivity and 82.2% specificity (area under the curve, 0.857; 95% confidence interval, 0.788-0.927). Conclusion: This study showed that the BMI can be considered a parameter for predicting surgical success in patients with LSCS and can be useful in clinical practice.

Implant success rates in full-arch rehabilitations supported by upright and tilted implants: a retrospective investigation with up to five years of follow-up

  • Francetti, Luca;Rodolfi, Andrea;Barbaro, Bruno;Taschieri, Silvio;Cavalli, Nicolo;Corbella, Stefano
    • Journal of Periodontal and Implant Science
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    • v.45 no.6
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    • pp.210-215
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    • 2015
  • Purpose: The aim of this retrospective study was to investigate the cumulative success rate, the implant survival rate, and the occurrence of biological complications in implants supporting full-arch immediately loaded rehabilitations supported by upright and tilted implants. Methods: The clinical records and periapical radiographs of patients who attended follow-up visits were collected, and information was recorded regarding marginal bone loss resorption, the occurrence of peri-implant infectious diseases, and the implant survival rate. Implants were classified as successful or not successful according to two distinct classifications for implant success. Results: A total of 53 maxillary and mandibular restorations including 212 implants were analysed, of which 56 implants were studied over the full five-year follow-up period. After five years, the cumulative success rate was 76.04% according to the Misch classification and 56.34% according to the Albrektsson classification. The cumulative implant survival rate was 100%, although one implant was found to be affected by peri-implantitis at the second follow-up visit. Conclusions: The cumulative success rate of the implants dropped over time, corresponding to the progression of marginal bone resorption. The prevalence of peri-implantitis was very low, and the implant survival rate was not found to be related to the cumulative success rate.

Surgical Treatment for Trigeminal Neuralgia

  • Park, Chang Kyu;Park, Bong Jin
    • Journal of Korean Neurosurgical Society
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    • v.65 no.5
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    • pp.615-621
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    • 2022
  • Various treatments for trigeminal neuralgia (TN) are known to yield initial satisfactory results; however, the surgical treatment has excellent long-term outcomes and a low recurrence rate. Surgical treatment addresses the challenge of vascular compression, which accounts for 85% of the causes of TN. As for surgical treatment for TN, microvascular decompression (MVD) has become the surgical treatment of choice after Peter J. Jannetta reported the results of MVD surgery in 1996. Since then, many studies have reported a success rate of over 90% for the initial surgical treatment. Most MVDs aim to separate (decompress) the culprit vessel from the trigeminal nerve. To increase the success rate of surgery, accurate indications for MVD and management of the offender vessels without complications are critical. In addition, if there is no vascular compression, partial sensory rhizotomy or internal neurolysis can be performed to improve surgical outcomes.

Comparison of Binocular Function and Surgical Outcomes of Tenacious Proximal Fusion and High Accommodative Convergence/Accommodation Ratio Types of Intermittent Exotropia

  • Park, Jun Woo;Lee, Soo Jung
    • Korean Journal of Ophthalmology
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    • v.32 no.6
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    • pp.483-487
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    • 2018
  • Purpose: To compare the characteristics and surgical outcomes in patients with tenacious proximal fusion (TPF) and high accommodative convergence/accommodation ratio (AC/A) types of intermittent exotropia. Methods: This study retrospectively enrolled 40 patients with intermittent exotropia, 23 with TPF and 17 with high AC/A. Binocular function was evaluated by Worth's 4-dot test. Patients underwent lateral rectus recession, and surgical outcomes were compared. Surgical success was defined as less than ${\pm}10$ prism diopters (PD) at 12 months postoperatively. Results: The proportion of diplopia at near, evaluated by Worth's 4-dot test, was significantly higher in patients with high AC/A than in those with TPF (35.3% vs. 4.3%, p = 0.029). The mean preoperative angles of deviation in TPF and high AC/A types were $28.3{\pm}4.4$ and $28.8{\pm}4.5PD$ at distances, and $14.7{\pm}4.2$ and $15.1{\pm}4.1PD$ at near. Twelve months after surgery, the mean angles of deviation in TPF and high AC/A types were $2.9{\pm}9.8$ and $1.2{\pm}9.6PD$, respectively, at distance and $1.7{\pm}7.7$ and $-1.3{\pm}11.3PD$ at near. The surgical success rates were similar in the TPF and high AC/A types (74.0% vs. 64.7%). Five (21.7%) patients with TPF and 2 (11.8%) with high AC/A type experienced recurrence, with consecutive esotropia occurring in 1 (4.3%) patient with TPF and 4 (23.5%) patients with high AC/A. Conclusions: The proportion of diplopia at near was higher in patients with high AC/A type than in those with TPF intermittent exotropia. However, the surgical success rates were not significantly different between the types.

Duration of Regain of Deep Pain Perception after Decompression Surgery as a Parameter of Surgical Outcome for Acute Thoracolumbar Disc Herniation Hansen Type I with Loss of Deep Pain Perception in Dogs

  • Park, Sung-Su;Lim, Ji-Hey;Byeon, Ye-Eun;Jang, Byung-Jun;Ryu, Hak-Hyun;Uhm, Ji-Yong;Kang, Byung-Jae;Kim, Wan-Hee;Kweon, Oh-Kyeong
    • Journal of Veterinary Clinics
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    • v.25 no.6
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    • pp.529-532
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    • 2008
  • The object of this study was to evaluate the durations from onset of neurological sign until surgery and regaining of the deep pain perception (DPP) after decompression as prognostic indicators for the outcome of decompression surgery in dogs with thoracolumbar intervertebral disc disease (IVDD). The compression lesions in the thoracolumbar vertebrae were localized by plain radiograph, computed tomography and neurological examination in 28 dogs with hindlimb paralysis. The follow up was carried out for 6 months after laminectomy. During the follow up, regaining DPP and walking ability were evaluated. Improvement to normal or paretic gait after surgery was judged as success of the surgical treatment.The success rate of surgical treatment was 70 % (7 out of 10 dogs) when surgical intervention was carried out within 24 hours but 38.9 % (7 out of 18) over 24 hours (P<0.05). The success rate of surgical treatment was 87.5 % (14 out of 16 dogs) when DDP was regained within 5 weeks after surgery but there was 0 % (0 out of 12 dogs) when DDP was not regained within 5 weeks after surgery (P<0.05). Other parameters such as compression rate in CT scan and laminectomy methods did not related with the success of the surgery. These results suggested that the time of surgery after onset and duration of regaining of DPP after decompression were useful parameter to predict the success of surgical treatment for thoracolumbar disc herniation in dogs.

Surgical Management of Coexisting Glaucoma and Cataract (녹내장과 백내장이 동반된 환자의 수술적 치료)

  • Cha, Soon-Cheol
    • Journal of Yeungnam Medical Science
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    • v.21 no.1
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    • pp.12-22
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    • 2004
  • The management of coincident glaucoma and cataract is not only a common clinical challenge but also an important research topic in the ophthalmic surgical field. The purpose of this article is to compare the different surgical options on the basis of their achievable postoperative intraocular pressure (IOP) control, success rates, and complication rates reported in the related literature, and to give advice on how to manage typical situations of patients with both glaucoma and cataract. Main topics were focused on indications and rationale of 3 surgical options (only cataract surgery first and later trabeculectomy, only trabeculectomy first and later cataract surgery, or simultaneous combined surgery). Modern clear corneal cataract extraction techniques resulted in a modest intermediate-term reduction of IOP and has considerably improved the success rates of combined glaucoma and cataract surgery. It also enabled future trabeculectomy to be successfully performed at a later date if necessary. Trabeculectomy alone achieved better IOP regulation than phacotrabeculectomy (combined surgery), but subsequent cataract surgery may compromise preexisting filtering bleb. Combined surgery augmented with mitomycin C achieved a lower IOP than combined surgery alone but had a higher complication rate. In conclusion, the choice of the preferred surgical method should be determined according to the target pressure, the amount of glaucomatous damage, and the grade of visual disturbance caused by the cataract. Phacotrabeculectomy with adjunctive mitomycin C offers visual improvement and achieves the best IOP lowering of all types of combined glaucoma and cataract surgery currently used but is associated with potentially sight-threatening complications.

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Retrospective Clinical Study on Flapless Implant Placement

  • Kim, Jong-Hee;Kim, Young-Kyun;Yi, Yang-Jin
    • Journal of Korean Dental Science
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    • v.5 no.2
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    • pp.54-59
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    • 2012
  • Purpose: The purpose of this study was to evaluate the prognosis (clinical outcomes) of one-stage flapless implant surgery based on success and survival rate and marginal alveolar bone loss. Materials and Methods: Ninety dental implants were placed according flapless surgical procedure in forty-one patients at Hospital between April 2004 and May 2009. The mean age of the patients was 54, and the patients were comprised of 24 men and 17 women. Each patient was investigated radiographically and clinically being with average follow up 49.7 period. Result: Average healing period is 4.45 month (maxilla: 5.31 month, mandible: 3.20 month) after installation and survival rate is 95.7% in this period. The survival rate and success rate at 1 year after function (prosthodontics setting) are 92.4% and 88.0%. At final observation, the survival rate and success rate are 90.2% (maxilla: 89.1%, mandible: 92.9%) and 84.8% (maxilla: 82.8%, mandible: 89.3%). The mean residual alveolar bone resorption at 1-year after function and final observation are 0.8 mm and 1.07 mm. Conclusion: Our study suggest that if appropriate surgical technique with proper patients selection, flapless implants surgery is predictable simple and safety technique.

Success and Failure of Surgical Endodontic Treatment in Molar Teeth

  • Geum, Yun-Seon;Lee, Jang-Ryeol;Kim, Hyeon-Cheol;Lee, Sang-Cheol;Kim, Yeong-Uk
    • Journal of Korean Dental Science
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    • v.3 no.2
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    • pp.12-19
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    • 2010
  • Despite the latest advancement made in its techniques and devices/apparatuses and the resulting rising expectation in the field of dental surgery, apicoectomy performed in the molar teeth remains a technical challenge and lacks evidence substantiated by long-term follow-up studies. This study sought to investigate the treatment outcomes and post-operative success rate in the root-end resected molar teeth accompanied by a high level of surgical risks due to their close proximity to the mandibular canal and maxillary sinus. A total of 68 patients who received treatment at Livingwell Dental Hospital between 2004 and 2010 and underwent apical surgery in the maxillary or mandibular molar area were enrolled in this study. A total of 160 roots collected from 75 molar teeth were subjected to surgical endodontic treatment and subsequently evaluated clinically as well as radiographically. Based on the results of the study, the clinical success rate was found to be 78.8% in cases involving radiological healing. Likewise, 90.7% of the roots recorded a robust clinical survival rate, but with incomplete healing as shown by radiography. The results indicate that the apical procedure involving molar teeth is a prognosis-friendly method that promises positive outcomes and higher success rate based on long-term follow-up observations.

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The Results and Prognostic Factors of Mitomycin C Trabeculectomy in Neovascular Glaucoma (신생혈관녹내장에 대한 Mitomycin C 섬유주절제술의 성적과 예후인자)

  • Kim, Yun-Tae;Cha, Soon-Cheol
    • Journal of Yeungnam Medical Science
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    • v.19 no.2
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    • pp.126-135
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    • 2002
  • Background: Neovascular glaucoma is common secondary glaucoma at high risk for failure of glaucoma filtering surgery. Recently, trabeculectomy with adjunctive mitomycin C trabeculectomy has been tried to improve the surgical success rate of conventional trabeculectomy. But, the long-term effects of mitomycin C trabeculectomy for neovascular glaucoma are unknown. Thus, we evaluated the long-term effects of mitomycin C trabeculectomy and its prognostic factors influencing the outcome. Materials and Methods: Medical records of 62 eyes of 55 neovascular glaucoma who had undergone mitomycin C trabeculectomy were retrospectively reviewed. Surgical success was defined as intraocular pressures of 21 mmHg or less with or without glaucoma medications and no loss of light perception. Surgical failure was defined as postoperative loss of light perception in patients with preoperative vision better than light perception, additional glaucoma surgery, or phthisis bulbi in patients with preoperative vision of no light perception. Results: Postoperative success was obtained in 37 (60%) out of 62 eyes after mean followup period of $23.9{\pm}16.2$ months. Using Kaplan-Meier survival analysis, cumulative success rate at the 6-, 12-, 24- and 36-month intervals were 85%, 71%, 57% and 52%, respectively. Success rate was greater in eyes with diabetic retinopathy than other causes(p=0.005) and in eyes with preoperative panretinal photocoagulation(PRP) than without PRP(p=0.015). However, Cox proportional hazard regression analysis revealed that preoperative PRP was not a significant risk factor for surgical failure. Conclusion: Prognosis of neovascular glaucoma caused by diabetic retinopathy was better than that caused by the other disorders following mitomycin C trabeculectomy. The author would suggest that mitomycin C trabeculectomy could be effective and relatively safe as the first procedure of choice before performing glaucoma drainage device implantation or cyclodestructive procedure.

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Thoracic Duct Embolization for Treatment of Chyle Leakage After Thyroidectomy and Neck Dissection

  • Sungmo Moon;Juil Park;Gyoung Min Kim;Kichang Han;Joon Ho Kwon;Man-Deuk Kim;Jong Yun Won;Hyung Cheol Kim
    • Korean Journal of Radiology
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    • v.25 no.1
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    • pp.55-61
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    • 2024
  • Objective: This study aimed to evaluate the safety and efficacy of intranodal lymphangiography and thoracic duct embolization (TDE) for chyle leakage (CL) after thyroid surgery. Materials and Methods: Fourteen patients who underwent intranodal lymphangiography and TDE for CL after thyroid surgery were included in this retrospective study. Among the 14 patients, 13 underwent bilateral total thyroidectomy with neck dissection (central compartment neck dissection [CCND], n = 13; left modified radical neck dissection (MRND), n = 11; bilateral MRND, n = 2), and one patient underwent left hemithyroidectomy with CCND. Ten patients (76.9%) had high-output CL (> 500 mL/d). Before the procedure, surgical intervention was attempted in three patients (thoracic duct ligation, n = 1; lymphatic leakage site ligation, n = 2). Lymphangiographic findings, technical and clinical successes, and complications were analyzed. Technical success was defined as the successful embolization of the thoracic duct after access to the lymphatic duct via the transabdominal route. Clinical success was defined as the resolution of CL or surgical drain removal. Results: On lymphangiography, ethiodized oil leakage near the surgical bed was identified in 12 of 14 patients (85.7%). The technical success rate of TDE was 78.6% (11/14). Transabdominal antegrade access was not feasible due to the inability to visualize the identifiable cisterna chyli or a prominent lumbar lymphatic duct. Among patients who underwent a technically successful TDE, the clinical success rate was 90.1% (10/11). The median time from the procedure to drain removal was 3 days (with a range of 1-13 days) for the 13 patients who underwent surgical drainage. No CL recurrence was observed during the follow-up period (ranging from 2-44 months; median, 8 months). There were no complications, except for one case of chylothorax that developed after TDE. Conclusion: TDE appears to be a safe and effective minimally invasive treatment option for CL after thyroid surgery, with acceptable technical and clinical success rates.