No split, no tenotomy transposition procedure for complete abducens palsy.
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ABSTRACT:
SUBMITTER: Murthy SR
PROVIDER: S-EPMC5549426 | biostudies-other | 2017 Jul
REPOSITORIES: biostudies-other
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Project description:PURPOSE:Superior rectus transposition has been popularized for the treatment of abduction deficiencies. Potential complications include induced vertical deviation and torsion. A new procedure, the inferior rectus transposition (IRT), may be similarly beneficial for patients at risk for postoperative vertical deviation or incyclotropia. The purpose of this study is to describe the outcomes of patients undergoing IRT. DESIGN:Prospective, interventional case series. METHODS:Five patients in an academic pediatric ophthalmology and strabismus practice with a complete lateral rectus palsy who underwent IRT were studied. Changes in anomalous head posture, ocular rotations, ocular alignment, and torsion preoperatively to postoperatively were compared. RESULTS:The patients ranged in age from 19-89 years. There was a significant correction in the angle of esotropia (ET) from 39±17? (14-55?) to 12 ± 9.8? (0-22?) postoperatively (P = .02). Two of 5 patients had preoperative hypertropia of the affected eye (1.4 ± 2.2?; range, 2-5?). One of those had no vertical deviation postoperatively and 1 patient resulted in 2? hypotropia. One patient without vertical misalignment preoperatively developed a small postoperative vertical deviation. Torticollis significantly improved from 31.4 ± 11.6° to 5 ± 5.8° (P = .004). All patients improved abduction, with a mean of -4.4 ± 0.5 preoperatively to -3.4 ± 0.9 postoperatively (P = .07). CONCLUSION:Initial postoperative follow-up in patients with abducens palsy undergoing IRT shows a significant improvement in ocular alignment and torticollis. In patients with preoperative hypertropia, IRT resulted in a downward shifting effect on the operated eye. IRT may be a beneficial procedure for patients with preoperative hypertropia or intorsion requiring transposition procedures. Future studies with larger populations and longer durations of follow-up will be required before this procedure can be recommended.
| S-EPMC5410180 | biostudies-literature
Project description:BackgroundHorizontal strabismus due to a weak rectus muscle can be treated with an augmented Hummelsheim procedure, in which both vertical rectus muscle tendons are split, resected by 4 mm, and reattached to the sclera adjacent to the weak rectus muscle. Compared with vertical rectus transposition, the procedure spares two ciliary vessels and does not require placement of augmentation sutures. In this study, we evaluated binocular alignment and ocular motility in patients with abducens nerve palsy treated with an augmented Hummelsheim procedure.MethodsThe medical records of consecutive patients with complete abducens nerve palsy who underwent the augmented Hummelsheim procedure, usually combined with medial rectus muscle recession, were retrospectively reviewed. Binocular alignment, ocular motility, and complications were analyzed.ResultsTen patients (age range, 12-57 years) met inclusion criteria for the study, of whom 9 of 10 had simultaneous medial rectus recession. Follow-up ranged from 1 week to 24 months. The augmented Hummelsheim procedure improved esotropia from 43(Δ) ± 5(Δ) preoperatively to 6(Δ) ± 7(Δ) postoperatively (P < 0.0001) and reduced abduction deficits from -4 to -3 (P < 0.0001). One patient with coexisting oculomotor nerve palsy developed consecutive exotropia; 2 had induced vertical deviations. There were no cases of anterior segment ischemia.ConclusionsThe augmented Hummelsheim procedure combined with medial rectus muscle recession reduced mean primary position esotropia and improved abduction in patients with complete abducens nerve palsy.
| S-EPMC4143379 | biostudies-literature
Project description:In the presence of bone loss, the Bristow or Latarjet procedure is used to alleviate anterior glenohumeral instability. The techniques have gradually improved under arthroscopy. However, such an arthroscopic procedure has a steep learning curve, lengthy operation time, and considerable risk of complications, inhibiting its rapid development. The current method of modified arthroscopic Bristow procedure with screw fixation without subscapularis split reduces surgical time, reduces the risk of nerve damage consequences, and is simple to apply. Technique Video Video 1 We present our modified arthroscopic Bristow procedure: screw fixation without subscapularis split. The patient is placed in the beach-chair position, and 5 portals are created. After performing a diagnostic arthroscopy examination, the coracoid process lower surface, tip, and base, and the conjoined tendon are identified. The soft tissue lateral to the conjoined tendon is released to a sufficient length to allow transferring the coracoid process. The coracoacromial ligament is excised at its coracoid insertion to expose its lateral and upper surfaces. Subsequently, the pectoralis minor muscle is released from the coracoid to ∼5 cm below the junctions between the pectoralis minor muscle and the conjoined tendon to ensure the transfer of the coracoid process will not be affected. A 1.2-mm K-wire is drilled into the coracoid under the guidance of a thin cannula. A PDS line is passed through the bone tunnel for traction and guidance. After ensuring an adequate length of the coracoid bone, it is osteotomized with a willow saw. Subsequently, the labrum and capsule are detached completely from the glenoid to the 6-o’clock position. The glenoid is refreshed by a burr. The upper edge of the subscapularis is pressed downwards by a switching stick until the 4-o’clock position of the anterior glenoid is exposed. A marking point is placed to assist in creating a tunnel at the 4-o’clock position. After drilling and measuring, a 1.2-mm K-wire is inserted into the tunnel to guide the screw. The coracoid is pulled out through portal D, its length is measured, and its osteotomy surface is trimmed to match the anterior glenoid surface. A hole is drilled from the center of the osteotomy surface to the tip of the coracoid with a 1.2-mm K-wire. The hole created by the 1.2-mm K-wire is drilled through with a 2.7-mm hollow drill. A cannulated screw with a diameter of 4 mm is implanted into the coracoid graft along the 1.2-mm K-wire, leaving 2 mm of the screw head above the osteotomy surface for the coracoid's final fixation. The lateral edge of the conjoined tendon is sutured with No. 2 ETHIBOND suture near the coracoid and kept sufficiently taut to prevent twisting during coracoid fixation. The coracoid with partial screw fixation is then inserted for the final fixation. The tip of the screw is positioned against the K-wire introduced through the glenoid tunnel in the previous phase. The K-wire is threaded through the screw, and the coracoid and screw are secured with a screwdriver. The final placement of the transferred coracoid is arthroscopically assessed through portal B. The postoperative anteroposterior radiograph shows that a single screw maintains the coracoid in place. The 3-dimensional computed tomography scan depicts the locations of the graft and screw. The transferred coracoid is seen at the 4-o’clock position, and the glenoid surface is well integrated with the coracoid graft’s surface. The scan also shows that the transferred coracoid is standing on the glenoid surface with a 90° rotation. (PDS, polydioxanone.).
| S-EPMC10466097 | biostudies-literature
Project description:PurposeTo present the results of bilateral superior rectus transposition with medial rectus recession in a case of chronic bilateral sixth nerve palsy.ObservationBilateral superior rectus transposition with medial rectus recession resulted in full correction of esotropia with resolution of horizontal diplopia, improvement in abduction, and regain of stereoacuity in our case. There was minimal limitation of adduction, with no abnormal vertical or torsional changes.Conclusion and importanceBilateral superior rectus transposition with medial rectus recession appears to be a useful procedure for surgical treatment of bilateral sixth nerve palsy with minimal side effects. Given its potential for reduced risk of anterior segment ischemia (ASI), it may have especially good value in the select group of patients at risk for ASI. Studies with larger sample size and longer follow up are needed to further evaluate this procedure and elucidate the variables in surgical technique for superior rectus transposition.
| S-EPMC5861632 | biostudies-literature
Project description:BackgroundTardy ulnar nerve palsy is the development of late onset ulnar nerve dysfunction and is usually treated by open anterior transposition of ulnar nerve. Open technique is done using a longitudinal incision about 6-8 inch. in length with chances of development of medial antebrachial cutaneous nerve neuromas.PurposeIn this study, we describe the technique of Endoscopic Anterior Transposition of Ulnar Nerve (EATUN procedure) to treat tardy ulnar nerve palsy and analyze the results.MethodsSeven patients diagnosed to have tardy ulnar nerve palsy was treated by EATUN. The humerus-elbow-wrist angle (HEW), pre- and post-operative intrinsic muscle power and sensory assessment, Dellon scores, and the Q-DASH was analyzed.ResultsThe minimum follow-up was 12 months (Mean 27.4 months, Range 12-36 months). Improvement in Dellon and Q-DASH scores following EATUN procedure was statistically significant. There was objective improvement of intrinsic muscle power and sensation on follow-up, though not statistically significant. No instance of neuroma of the medial cutaneous nerve of forearm was noted.ConclusionsThe endoscopic anterior transposition of the ulnar nerve is a good option in surgical management of tardy ulnar nerve palsy.Level of evidenceTherapeutic Level IV.Supplementary informationThe online version contains supplementary material available at 10.1007/s43465-021-00366-w.
| S-EPMC8046855 | biostudies-literature
Project description:Biceps tenotomy is a common procedure performed in arthroscopic shoulder surgery. Numerous studies have demonstrated the effectiveness of both biceps tenotomy and tenodesis to relieve pain and restore function for the diagnoses of bicipital tenosynovitis, SLAP tears, rotator interval pulley lesions, and failed SLAP repairs. It is also frequently performed as a concomitant procedure with arthroscopic rotator cuff repair. We report a technique to improve the efficiency of arthroscopic bicep tenotomy using a biceps squeeze maneuver. This is a simple method of manually squeezing the biceps muscle belly while performing the arthroscopic biceps tenotomy. This shortens and tensions the intra-articular portion of the tendon to facilitate a more safe and efficient procedure.
| S-EPMC7695749 | biostudies-literature
Project description: Not available
| S-EPMC8213288 | biostudies-literature
Project description:The long head of the biceps tendon is frequently involved in shoulder pathologies, often in relation to inflammatory or degenerative damage to the rotator cuff. Biceps tenodesis in the bicipital groove and tenotomy are the main treatment options. Tenotomy of the long head of the biceps tendon is a simpler and quicker procedure than tenodesis, and it does not require the use of implants. However, retraction of the biceps tendon, leading to Popeye deformity, and biceps muscle cramps are common complications after tenotomy. Therefore we propose an arthroscopic technique for tenotomy that limits the risk of Popeye deformity. This procedure consists of creating a loop at the severed end of the biceps tendon, which prevents the tendon from retracting into the bicipital groove.
| S-EPMC4175155 | biostudies-literature
Project description:ImportanceBoth vertical rectus belly transposition (VRBT) and superior rectus transposition (SRT) can be performed simultaneously with ipsilateral medial rectus recession (MRc) and have been shown to be effective for chronic sixth nerve palsy. However, it is unclear whether VRBT is superior to SRT in correcting esotropia.ObjectiveTo compare the effectiveness of modified VRBT plus MRc (mVRBT-MRc) vs augmented SRT plus MRc (aSRT-MRc) in Chinese patients with chronic sixth nerve palsy.Design, setting, and participantsThis parallel-design, double-masked, single-center, randomized clinical trial was conducted from January 15, 2018, to May 24, 2021. The follow-up visits were scheduled at 1 month and 6 months. Eligible Chinese participants with unilateral chronic sixth nerve palsy were randomly assigned to receive either mVRBT-MRc (VRBT group) or aSRT-MRc (SRT group).InterventionsmVRBT-MRc or aSRT-MRc.Main outcomes and measuresChange of horizontal deviation in primary position from baseline to 6 months.ResultsOf the total 25 eligible participants, the mean (SD) age was 45.4 (12.6) years, with 10 male participants (40%) and 15 female participants (60%). Thirteen participants (52%) were randomly assigned to the VRBT group, and 12 (48%) were randomly assigned to the SRT group. At baseline, the mean (SD) horizontal deviation was 65.7 (10.8) prism diopters (Δ) in the VRBT group and 60.5Δ(14.1Δ) in the SRT group. Similar amounts of MRc were performed in both groups. At 6 months, the horizontal deviation changed from baseline by 66.3Δ in the VRBT group and by 51.5Δ in the SRT group. The adjusted group difference was 10.9Δ (95% CI, 5.3Δ-16.6Δ), favoring the VRBT group (P = .001). Four times as many participants corrected more than 60Δ with mVRBT-MRc compared with aSRT-MRc. The group difference of the improvement of abduction limitation was -0.2 (95% CI, -0.8 to 0.5; P = .64). Although there was a higher proportion of undercorrection in the SRT group (difference, 45%; 95% CI, 16%-75%; P = .01), no differences were identified for other suboptimal outcomes between groups.Conclusions and relevanceCompared with aSRT-MRc, mVRBT-MRc showed better effect in correcting esotropia with no differences detected for other suboptimal outcomes. mVRBT-MRc may be a promising alternative surgical procedure for chronic sixth nerve palsy, particularly for large esotropia of more than 60Δ, if these results are confirmed in larger, diverse cohorts with longer follow-up.Trial registrationChiCTR Identifier: ChiCTR-INR-17013705.
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Project description:The presence of integrons was assessed in gut bacteria isolated from wild-caught prawns. A pseudomonad was recovered that contained a Tn402-like class 1 integron with a complete transposition module and two gene cassettes. One cassette was identical to a previously described cassette from a chromosomal class 3 integron in Delftia tsuruhatensis.
| S-EPMC3019745 | biostudies-literature