Endoscopic Decompression of a Gouty Tophus at the Hand Dorsum.
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ABSTRACT:
SUBMITTER: Lui TH
PROVIDER: S-EPMC5495938 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The olecranon bursa is very commonly involved in tophaceous gout because of the tendency of monosodium urate crystals to deposit in superficial structures with low temperatures. Surgery is indicated if the olecranon tophus is recalcitrant to medical treatment. Open surgery requires a long incision over the tophus and may lead to wound complications. Endoscopic debridement of the tophus can reduce the risk of wound complications. In this Technical Note, the technical details of endoscopic decompression of an olecranon tophus are described. This endoscopic technique also allows debridement of tophus infiltration of the triceps tendon.
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Project description:Tophaceous deposition of tendon can result in spontaneous patellar tendon rupture. Surgical therapy may be needed to control symptoms and prevent tendon rupture. Open debridement of the lesion requires a lengthy incision over the lesion; this may result in symptomatic scar adhesion of the patellar tendon or an unhealed wound with persistent tophaceous discharge. Moreover, the other part of the patellar tendon cannot be examined through the incision. We describe a technique for endoscopic resection of a gouty tophus of the patellar tendon. It has the advantage of small incisions away from the lesion and tendon and minimizes wound problems. The whole patellar tendon can be examined endoscopically.
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Project description:We present a 24-year-old male who developed an infected hematoma that resulted in sciatic nerve injury after he underwent an endoscopic sciatic nerve decompression. He underwent urgent hematoma evacuation and cultures speciated as Salmonella. At 4 months' follow-up, the patient's nerve had improved motor and sensory function. This case highlights the importance of obtaining appropriate hemostasis at the end of an endoscopic sciatic nerve decompression.
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Project description:ObjectiveCervical osseous foraminal stenosis (COFS) results from the uncinate process and facet hyperostosis. Currently, the optimal surgical technique for the treatment of COFS remains controversial.Materials and methodsPatients with COFS presenting radiculopathy underwent posterior endoscopic cervical foraminotomy by the circumferential decompression technique. The neck disability index (NDI), the visual analogue scale (VAS), and the modified MacNab criteria were used to evaluate the outcomes. In addition, the range of motion (ROM) and the slippage distance between the operated vertebrae in flexion-extension position were measured to evaluate the stability of the cervical spine.ResultsThere were 24 consecutive patients in the study. The mean follow-up period was 16.2 months (range: 12-26 months). The NDI and VAS scores for arm/neck pain improved significantly from preoperatively to the last follow-up. The satisfaction rate by modified MacNab criteria was 91.7% on the third postoperative day and 100% on the day of final follow-up. There were no significant differences in intervertebral ROM or slippage distance between the last follow-up and preoperatively (P = 0.968, P = 0.394). Arm pain occurred in one patient, and sustained fingers numbness in two patients, but these symptoms resolved at the last follow-up.ConclusionsPosterior endoscopic cervical foraminotomy by the circumferential decompression technique is a safe and effective treatment for COFS. Moreover, it preserves the stability and physiological mobility of the cervical spine.
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Project description:Endoscopic spine surgery for the treatment of degenerative spinal diseases from lumbar to cervical spine has accelerated over the past 2 decades. Posterior endoscopic cervical discectomy (PECD) has been described as a safe, effective, and minimally invasive procedure for cervical radiculopathy or even part of the myelopathy. This procedure also has been validated with comparable outcomes to open and microscopic surgery. Radiculopathy due to foraminal disc herniation or foraminal stenosis should be the optimum indications of this procedure. Intraoperative 3-dimensional navigation can help surgeons to get quick and great quality guidance for endoscopic surgeons. In this review, we will focus on the technical details and evidence-based results of PECD which is a promising procedure for cervical radiculopathy with the advantages of a minimally invasive method.
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Project description:The perception of the body and its parts has traditionally been studied using the conscious body image. Here, we determine the implicit representation of the hand. Participants were sequentially shown two life-size images of either the dorsal or palmar surface of their hand. In one interval either the horizontal or vertical dimension of the image was varied using an adaptive staircase, while the other interval contained the full-size, undistorted image. Participants reported which image most closely matched their hand. The staircase honed in on the distorted image that was equally likely to be judged as matching their own hand as the accurate image. The implicit representation was taken as midway between these two images. The experiment was repeated with different hand orientations. Perceived width depended on the orientation, with differences found between the upright and right orientations. Interestingly, the perceived length of the dorsum and palm were different from each other-length of the dorsum was overestimated whereas palm length was perceived accurately. This study reveals distortions of the implicit representation of the hands in healthy individuals.
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Project description:Core decompression is a joint-preserving surgery feasible in early-stage avascular necrosis of the femoral head. An arthroscopically/endoscopically aided development of this procedure is presented to overcome some drawbacks of the standard technique. Conventional imaging may underestimate the articular damage; thus a preliminary hip arthroscopy helps to identify those patients with significant joint damage, who might not benefit from the procedure. The standard fluoroscopically guided core decompression does not allow precise targeting or reliable debridement of the lesion. Tunnel endoscopy helps the surgeon to aim precisely at the lesion and to debride it thoroughly, with accurate visual verification. In conclusion, the arthroscopic-endoscopic assistance may lead to more accurate patient selection, more precise targeting, and more complete debridement, with no apparent disadvantages.
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Project description:BackgroundLeg pain and back pain after lumbar laminectomy and spinal decompression fusion surgery are common and often related to persistent lumbar foraminal or lateral recess stenosis. Although persistent symptoms often stem from incomplete decompression during the primary index surgery, recurrent symptoms may also be the result of intervertebral cage subsidence due to loss of intervertebral and neuroforaminal height.ObjectiveThe aim of this study was to investigate the feasibility of using the outpatient transforaminal decompression procedure as an alternative to inpatient open procedure in revision decompression surgery, with the intent of minimizing the incidence of perioperative and postoperative surgical complications while reducing both direct and indirect costs of surgical treatment, shortening time to patient postoperative narcotic independence, and shortening time of patient return to daily activities.MethodsA total of 48 patients with conclusive diagnostic imaging and interventional workup underwent endoscopic transforaminal and lateral recess decompression for both persistent or recurrent leg and/or low back pain following previous lumbar laminectomy (22 patients) or decompression fusion surgery (26 patients). In addition to radiographic studies, patients were followed for a minimum of 2 years postoperatively, and clinical outcomes were evaluated with the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified Macnab criteria.ResultsAt final follow-up, patients with single- and 2-level prior surgeries reported an average ODI reduction following their secondary surgery of 44.6%, with an average final score of 14.8. Less favorable ODI score reductions following secondary surgery (23.8%) were reported by patients who had more than one or a complex prior multilevel surgery. According to the modified Macnab criteria, "excellent" and "good" results were obtained with the secondary surgery in 79.1% (38 of 48) of patients with no more than a single 1- or 2-level prior lumbar surgery. The mean VAS score decreased from 7.7?±?1.8 preoperatively to 2.3?±?1.1 at final follow-up (P?<?.01). Fair and poor results with the secondary surgery were seen in 20.9% (10 of 48) of patients with several prior surgeries or complex multilevel previous lumbar surgeries. The level distribution for secondary surgery was as follows: L4-5 segment (26 levels; 54.1%), L5-S1 (14 levels; 29.2%), L3-4 (7 levels; 14.6%), and the L2-3 level (1 level; 2.1%). Postoperative complications were limited to irritation of the dorsal root ganglion, which occurred in 25% (12 of 48) of patients. There were no wound infections, nerve root injuries, foot drop, or admissions to a hospital for further postoperative care. All patients with "excellent" and "good" outcomes measured by modified Macnab criteria, who were working before and after the primary and secondary surgeries (27 of 38), reported earlier return to work after the endoscopic outpatient surgery (2.6?±?0.8 weeks) than with the prior inpatient open spinal surgery (8.1?±?4.5 weeks). Based on the 2012 Medicare fee schedule for professional fees, direct costs were 40.6% and indirect costs were 37.1% lower with the secondary endoscopic surgery compared with primary open surgery.ConclusionsTransforaminal decompression is an effective alternative to open revision lumbar spinal surgery to treat symptomatic spinal stenosis after previous lumbar surgery in patients with persistent or recurrent leg and low back pain. It can be safely done in an outpatient setting, while realizing savings in direct and indirect costs.
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Project description:Ulnar nerve entrapment can be treated by a number of surgical techniques when necessary. Endoscopic techniques have recently been developed to access the ulnar nerve by use of a minimally invasive approach. However, these techniques have been considered difficult and, many times, dangerous procedures, reserved for experienced elbow arthroscopic surgeons only. We have developed a new endoscopic approach using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) that may be easier and safer. Standardization of the technique was previously developed in cadaveric models to achieve the required safety, reliability, and organization for this procedure, and the technique was then used in a live patient. In this patient the nerve entrapment symptoms remitted after the surgical procedure. The robotic surgical procedure presented a cosmetic advantage, as well as possibly reduced scar formation. This is the first note on this surgical procedure; the procedure needs to be tested and even evolved until a state-of-the-art standard is reached.
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