Browsing by Subject "Intraoperative Complications"
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Item Factors that Predict Poor Outcome after Treatment of Un-Ruptured Anterior Communicating Artery Aneurysms(2014-02-04) Krishnan, Govind; White, JonathanINTRODUCTION: Management of un-ruptured anterior communicating artery (ACOM) aneurysm is variable. The objective of this study was to identify demographic information, presentation indices, and clinical information that could help predict pattern outcomes after undergoing treatment for an un-ruptured ACOM aneurysm. METHODS: The study was a retrospective review of 139 patients with un-ruptured ACOM aneurysms from 2007 to 2012, who underwent either microsurgical clipping or endovascular coiling to treat the aneurysm. Demographics, medical history, presenting condition and patient outcomes were analyzed. The outcome of the treatment was quantified using the Glasgow Outcomes Score. A score of 3 or greater at discharge was considered favorable. Multivariate regression analysis was used to identify significant predictors of poor outcomes. RESULTS: A favorable outcome at discharge was achieved in 116 of the 139 total patients (83.45%). Multivariate analysis identified patient age grated than 70 (p<0.005), history of prior brain injury or surgery (p<0.005), current but not precious smoking (p<0.05), aneurysms of size greater than 20 mm (p<0.05), duration of temporary occlusions greater than 20 minutes (p<0.001), and the use of microsurgical clipping (p<0.005) as significant predictors of poor outcome. CONCLUSION: Age over 70, prior history of brain injury, current smoking, and an aneurysm size greater than 20 mm, along with the use of clipping and a duration of temporary occlusion greater than 20 minutes are the strongest predictors of poor outcome from treatment of un-ruptured ACOM aneurysms. This would indicate that treatment should be reconsidered in patients with any of the above risk factors and coiling should be attempted whenever possible.Item Minimizing Insertion Trauma with a Novel Shape Memory Polymer Cochlear Implant Array(2016-01-19) Lee, Roxanne; Pham, Tiffany; Ajieren, Hans; Shao, Dongmei; Voit, Walter; Lee, KennethHYPOTHESIS: Novel self-coiling electrode arrays made of shape memory polymer allow for atraumatic implantation of cochlear implants, minimizing loss of residual hearing and maximizing hearing outcomes for cochlear implant patients. BACKGROUND: Cochlear implants are effective devices in improving the hearing experiences of patients with severe to profound hearing loss. However, current cochlear implants are linear and collide with cochlear walls upon implantation into the cochlear spiral. This traumatic contact results in destruction of inner ear structures and a subsequent inflammatory response, leading to loss of residual hearing and submaximal patient outcomes post-implantation. Shape memory polymers (SMP), which can store a metastable shape and return to it in response to a stimulus, can be customized to fit perfectly into a patient's cochlea. Thus, an SMP cochlear implant electrode array can be straight and stiff enough to facilitate implant manufacturing, yet soften upon warming to body temperature and self-navigate through the cochlear spiral without contacting cochlear walls for totally atraumatic implantation. RESULTS: We have created a novel shape memory polymer cochlear implant electrode array that self-navigates through the cochlear spirals to allow for full and completely atraumatic insertion. We have also constructed a robotic linear actuator to provide consistent and controllable insertion of our SMP implants. Histological studies performed on implanted rat cochlea show lack of trauma to inner ear structures in cochlea implanted with SMP implants, indicating the superiority of our SMP implants over more traumatic conventional linear implants. CONCLUSIONS: We have demonstrated that shape memory polymers can be used in a novel way to make self-coiling cochlear implants that offer full yet atraumatic insertion, minimizing the adverse side effects usually experienced with implantation of more traumatic conventional linear implants.Item Perioperative cardiovascular evaluation and recommendations for noncardiac surgery(2004-08-26) Rutherford, John D.Item Resident Complicaitons of Intravitreal Injections at a Large County Hospital(2018-01-23) Balachandar, Neeraja; Bolisetty, Keerthana; Robertson, ZacharyINTRODUCTION: Intravitreal injections (IVIs) have now surpassed cataract surgery as the most frequently performed procedure in ophthalmology. Their incidence has increased from less than 3,000 in 1999 to more than 2.3 million in 2012. The most common pharmacologic agents administered intravitreally inhibit angiogenesis by blocking vascular endothelial growth factor. Diabetic macular edema, exudative age-related macular degeneration, and venous-occlusion associated macular edema are the most common indications. As such, IVI usage will only increase in the future as the population ages, new medications become available, and indications broaden. With IVIs being performed at increasing rates at the Parkland county hospitalメs resident ophthalmology clinic, identification of an accurate risk profile must be delineated, including possible complications during cataract surgery. METHODS: A retrospective chart review of patients who received one or more IVIs by an ophthalmology resident at Parkland between 01/2010 and 07/2016 was conducted. Charts were reviewed for a variety of IVI-related complications as well as the incidence of posterior capsule rupture (PCR) during cataract surgery, after one or more IVIs. RESULTS: 1893 eyes (from 1300 subjects) that had undergone at least one IVI were included. Of a total of 8642 IVIs that were reviewed, 76 complications (0.88%) were noted. Their nature ranged from relatively non-vision threatening (corneal abrasion, ptosis, and posterior vitreous detachment) to severely vision threatening (endophthalmitis, intraocular pressure (IOP) elevation, retinal detachment (RD), and other patient movement-related complications). The majority of complications did not occur at a significantly higher or lower rate than those reported in the literature. However, a significantly lower rate of RD (p=0.039) and a significantly higher rate of acute and chronic IOP elevation (p=0.001) was found. Further, of 354 cataract surgeries included and reviewed on eyes with prior IVIs, PCR occurred 12 eyes. Of these 13 eyes, 7 eyes were excluded for a prior history of pars plana vitrectomy, a known independent risk factor for PCR. This resulted in a PCR rate of 1.41% compared to average rates in literature of 1.9-2.1% (p=0.677). DISCUSSION: Resident administered IVIs at Parkland pose an overall low risk of complication, minimally different from IVIs administered at other institutions. The PCR rate in eyes with a history of IVIs at Parkland, excluding previously vitrectomized eyes, is not significantly different than the standard rate in literature. This data will prove useful in analyzing the unique risks of IVIs and subsequent cataract surgeries in individual patients. The etiology of the increased rates of IOP elevations at Parkland requires further investigation.