Coronary sinus perforation is a relatively uncommon but much feared complication that may occur during the placement of left ventricular pacing lead. Coronary sinus perforation, especially in the presence of an obstructive flap, usually indicates the need to abandon the implantation attempt, as there are difficulties in crossing the obstructive flap as well as uncertainty of whether the lead is in the true lumen or into the pericardial space. We describe our experience in successfully placing the left ventricular lead safely despite the problems arising from these circumstances.
Many studies have shown that tracheobronchial stenting is effective in relieving respiratory distress secondary to major airway obstruction due to lung or oesophageal cancer. A retrospective review on the benefits and complications of self-expandable metallic stent (SEMS) insertion through flexible bronchoscopy for the palliative treatment of upper airway obstruction in University Malaya Medical Centre was performed. Ten patients underwent this procedure. Relief of dyspnoea was immediate following stent insertion in all patients. Stent migration occurred in one patient and three patients had restenosis of the central airway. We conclude that tracheobronchial stenting via flexible bronchoscopy is feasible and safe.
Laparoscopic repair of ventral and incisional hernia has become increasingly popular as compared to open repair. The procedure has the advantages of minimal access surgery, reduction of post operative pain and the recurrence rate. A prospective study of laparoscopic incisional hernia repair was performed in our center from August 2002 to April 2004. Eighteen cases (n: 18) were performed during the study period. Fifteen cases (n: 15) had open hernia repair previously. Sixteen patients (n: 16) had successful repair of the hernia with the laparoscopic approach and two cases were converted to open repair. The mean hernia defect size was 156cm2. There was no intraoperative or immediate postoperative complication. The mean operating time was 100 +/- 34 minutes (75 - 180 minutes). The postoperative pain was graded as mild to moderate according to visual analogue score. The mean day of discharge after surgery was two days (1 - 3 days). During follow up, three patients (16.7%) developed seroma at the hernia sac which was resolved with conservative management after three weeks. One (5.6%) patient developed recurrence six months after surgery. In conclusion, laparoscopic repair of incisional hernia particularly recurrent hernia has been shown to be safe and effective in our centre. However, careful patient selection and acquiring the necessary advanced laparoscopic surgical skills coupled with the proper use of equipment are mandatory before embarking on this procedure.
This clinical case report details the clinical sequence of a 78-year-old male receiving prosthetic rehabilitation using an implant-supported screwretained fixed partial denture. Despite the limitations imposed, the aesthetic and functional demands of the patient were fulfilled by this prosthetic rehabilitation. The importance of detailed prosthetic planning and evaluation prior to implant surgery is essential, therefore ideally, it should be done by the same operator or a team of operators working together. Problems can arise when the construction of the prosthesis is performed by other people who are not involved in the planning stage.
Total femur endoprothesis is an alternative replacement for massive malignant bone tumor with intramedullary extension or skip lesion. Four patients underwent total femoral resection and replacement with megaprosthesis: three had primary malignant bone tumor and one had salvage procedure for aseptic loosening of the distal femoral replacement. Tumor-free margins were achieved in all patients with two patients required vascularized latissimus dorsi free flap cover for reconstruction of soft tissue defects. The average follow-up was 24 months (range 16 - 60 months). All four patients were still alive with three of them being disease-free and one survived even with the presence of lung metastasis. The functional results obtained were either excellent or good in all patients in accordance to the Musculoskeletal Tumors Society grading system.
A study of nerve regeneration through a 1cm defect in the peroneal component of the sciatic nerve was performed on sixteen rabbits. Either silicone or polytetrafluoroethylene (PTFE) tubes or nerve graft were used to bridge the defect and the opposite limb was not operated upon. The rabbits that underwent nerve grafting had favourable findings. In the PTFE group, a nerve-like structure was seen at the former gap site and histology confirmed viable axons within the tubes and distal to the repair site. In the silicone tube group, there were no myelinated axons demonstrated. The axonal count for the grafted nerves and the nerves repaired with PTFE tube are on average 80.4% and 38.2% of that of the unoperated nerve, respectively. On average, the percentage anterior compartment muscle weight (expressed as a percentage of the unoperated limb) for the silicone, PTFE and nerve graft groups are 42.3%, 42.1%, and 72.7% respectively. The results show that although, PTFE conduits can bridge a nerve defect of 1cm, nerve grafting provides a superior and more predictable outcome.
The aim of this study was to evaluate bovine pericardium surgical patch in rat model. Bovine pericardial sacs collected from local abattoir were cleaned, disinfected and cut into pieces of 3 by 2.5cm and preserved in 99.5% glycerol. Full thickness abdominal wall defects of 3 by 2.5 cm were created in 30 adult male Sprague Dawley rats and repaired with glycerol preserved pieces. The rats were serially sacrificed in a group of six rats at 1,3,6,9 and 18 weeks post-surgical intervals for morphological and tensometeric study. Macroscopically, no mortality or postoperative surgical complications was encountered except slight adhesions between implanted grafts and some visceral organs in 10% of the rats. Microscopically no calcification or foreign body giant cell formation was found in the explanted grafts. The implanted grafts were replaced gradually with recipient tissue, which made mainly of dense collagenous bundles. The healing strength between the implanted grafts and the recipient abdominal wall was gradually increased with time. The results of this study showed that glycerol preserved bovine pericardium act as scaffold for transformation into living tissue without clinical complications such as that associated with prostheses.
Missing teeth can be due to hypodontia, trauma or extraction. In general, the options for treatment depend on the severity of the hypodontia and the severity of the malocclusion. Occasionally, the space from missing teeth has to be maintained for prosthetic replacement and require an orthodontic/restorative approach. It is very important to ensure the space maintained is adequate for aesthetic reason so that it can be replaced with a prosthesis after the orthodontic treatment is completed. This article discusses a new innovation and clinical technique for maintaining this space during orthodontic treatment by using an acrylic tooth with several modifications. This innovation will be illustrated using two cases.
An alternative technique of superior vena cava obstruction bypass using bovine pericardial conduit is described. The patient in this case had recurrent bilateral thrombophlebitis and thrombosed saphenous veins. Most of the surgical techniques reported in the literature so far have described the use of polyethylene terephthalate (Dacron) graft, polytetrafluoroethylene graft, autologous pericardial patch, and spiral vein graft. The use of synthetic grafts has been plagued with high rates of thrombosis. The pathology, clinical presentation, surgical technique, and outcome are discussed.