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Journal articles on the topic 'Failed scar'
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1
DE SMET, L., and G. VANDEPUTTE. "Pedicled Fat Flap Coverage of the Median Nerve after Failed Carpal Tunnel Decompression." Journal of Hand Surgery 27, no. 4 (2002): 350–53. http://dx.doi.org/10.1054/jhsb.2002.0780.
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We reviewed 14 patients treated with either an ulnar or a hypothenar fat flap for recurrent carpal tunnel syndrome and scar tenderness. Nine patients were satisfied and there were few complications. One patient had delayed skin healing and another developed a hypertrophic scar.
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Drayton, Ka’la D., and Alan Babigian. "Lumbar Fusion Debris Resulting in Painful Foreign-body Reaction in Abdominal Scar." Plastic and Reconstructive Surgery - Global Open 13, no. 2 (2025): e6555. https://doi.org/10.1097/gox.0000000000006555.
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Summary: Scar formation is a foreseeable outcome in wound healing. Patients frequently undergo scar revision to improve aesthetic appearance or function. Herein, we present the case of a 49-year-old woman who presented with a painful scar on the abdominal wall. High-resolution computed tomography failed to reveal any underlying source of the abdominal pain. During scar revision, she was found to have extensive fibrosis resulting from a foreign-body response to spinal debris.
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N., P. Honcharuk, and R. Kovyda N. "Investigation of uterine vessel perfusion of the failure uterus scar after cesarean section." Reproductive health of woman 5 (December 31, 2020): 21–23. https://doi.org/10.30841/2708-8731.5.2021.224488.
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In modern conditions, due to the increased frequency of cesarean section, which is not only a method of surgical delivery of pregnant women, but also surgery, there are problems in the reproductive health of operated women. Given the solution of many aspects of re-cesarean section, the issues of determining the diagnostic criteria for failure of uterus scar, their diagnostic value and use in practical medicine remain debatable. <strong>The objective:</strong> the investigate the features of uterine perfusion in pregnant women after a previous cesarean section and develop criteria for predicting the failure of the uterus scar. <strong>Materials and methods.</strong> A comprehensive two-stage (before and during pregnancy) examination of 180 women with a uterus scar after a previous cesarean section for the period from 2014–2019. Women were divided into groups and subgroups depending on the time of pregnancy. <strong>Results.</strong> Based on the conducted clinical and anamnestic data and the results of ultrasound examinations of the operated uterus, we detected changes in the blood flow of the uterine arteries and developed an arterial perfusion index in pregnant women. Using the proposed index, the features of arterial perfusion in women of childbearing age, depending on the time of pregnancy and the failure of the uterus scar after a previous cesarean section. This allowed us to determine the limit values of this indicator for each group of women, in which the value of this indicator differed significantly from healthy women. The proposed limit levels of uterine perfusion allow to diagnose uterine perfusion disorders during pregnancy at different times. <strong>Conclusion.</strong> Determining the arterial perfusion index in pregnant women expands the diagnostic capabilities of physician in determining the condition of the postoperative uterus scar after a previous cesarean section and is an additional preventive measure to determine its failure. The output of the values of this indicator beyond the predicted threshold values will require additional diagnostic actions on the part of the physicians to find additional combined pathology that may affect uterine blood perfusion.
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B., Hiremath P., Vinothini Anandabaskar, Nivedhana Arthi, Rohini E., and Indu N. R. "A rare case of caesarean scar ectopic pregnancy: a case report." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 3 (2020): 1315. http://dx.doi.org/10.18203/2320-1770.ijrcog20200925.
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Scar ectopic pregnancy is a condition where the gestational sac implants into the previous caesarean scar site. Although it is a rare entity, its incidence is increasing due to rising rates of caesarean deliveries. Here authors report a case of caesarean scar ectopic pregnancy managed by laparotomy with caesarean scar ectopic excision following failed medical management. The patient recovered without any intraoperative or postoperative complications. An early diagnosis and management are vital in preventing maternal morbidity and mortality.
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Shojai, Raha, Pascale Roblin, and Léon Boubli. "Failed early medical abortion: Beware of the uterine scar! – Case report." European Journal of Contraception & Reproductive Health Care 17, no. 3 (2012): 237–39. http://dx.doi.org/10.3109/13625187.2012.671386.
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Jain, A., S. Bhatia, G. Mediratta, and A. Kumar. "Laparoscopic Management of Cesarean Scar Ectopic Pregnancy after Failed Medical Management." Journal of Minimally Invasive Gynecology 27, no. 7 (2020): S79. http://dx.doi.org/10.1016/j.jmig.2020.08.618.
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Bera, Surendra N., and Partha P. Sharma. "Vaginal delivery at term with previous one cesarean section: is it safe?" International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 8 (2018): 3147. http://dx.doi.org/10.18203/2320-1770.ijrcog20183307.
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Background: Post cesarean pregnancies are high risk pregnancy and main concern is uterine scar rupture with increasing maternal and perinatal risks, for vaginal birth after cesarean delivery (VBAC). Objective of this study is to know neonatal and maternal outcome at term who attempt vaginal delivery with previous one cesarean section presenting in active stage of labor.Methods: A total of 277 pregnant women with single live fetus at term, cephalic presentation with previous one cesarean section, underwent a trial of labor and outcome of successful and failed vaginal birth were noted.Results: Trial of labor was successful in 52.3% and failed in 47.7% (p=0.269). VBAC was successful where the previous cesarean section indications were fetal distress (79% versus 21%, p=0.000), pregnancy induced hypertension (77.3% versus 22.7%, p=0.000) and fetal growth restriction (81.8% versus 18.2%, p=0.000), when compared with failed trial of labor who required emergency cesarean section in pre-labor rupture of the membranes (8.3% versus 91.7%, p=0.000) and dystocia (3.3% versus 96.7%, p=0.000). VBAC was successful at gestational age of 37 0/7-38 6/7 weeks (p=0.000). In the failed VBAC women who required emergency cesarean section there was significant early neonatal death (p=0.025). Scar dehiscence and hospital stay with or without complications were more in the failed VBAC group.Conclusions: Early neonatal death and duration of hospital stay were significantly more in the failed VBAC, who were posted for emergency cesarean delivery. Scar dehiscence occurred in the failed VBAC group. Women presenting at 37 0/7 to 38 6/7 weeks of gestation with cephalic presentation in active stage of labor who had previous cesarean section done for fetal distress, pregnancy induced hypertension and fetal growth restriction with inter pregnancy interval of > 24 months can be planned and counselled for VBAC trial of labor.
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Wang, Hyun, Lan Sook Chang, and Youn Hwan Kim. "Tissue Recycling with Split-Thickness Skin Graft Harvested from a Failed Free Flap." Journal of Wound Management and Research 18, no. 3 (2022): 245–48. http://dx.doi.org/10.22467/jwmr.2022.02236.
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Failure of free flaps is frustrating for both patients and surgeons. Since a large amount of tissue was already used in the first operation, much consideration should be given to donor site and tissue preservation in revision procedures. Recycling tissue by salvaging skin from the failed flap is one option. A 59-year-old man with a scar contracture deformity on his right medial thigh underwent scar tissue excision and thoracodorsal artery perforator free flap coverage. Unfortunately, flap compromise was found on the second postoperative day and flap salvage failed due to extensive thrombus. A second thoracodorsal artery perforator free flap from the contralateral side was used for revision surgery. A split-thickness skin graft was performed with skin harvested from the failed flap to cover the second donor site. Multiple hand-held retractors provided appropriate tension for harvesting the skin. The grafted skin was successfully taken after 3 weeks. This study explores the viability of a split-thickness skin harvested from a failed flap with more than 48 hours of ischemic time. The reusability of skin from a failed free flap in revision surgery can both minimize the need for additional donor sites and reduce unnecessary pain.
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Spyridon Maragkos, Giampietro Bertasi, and Mariana Peroni. "Treatment of retractile scar after a hypetrophic scar (HSs) in the hand with ADM (Dermacell)." International Journal of Frontiers in Science and Technology Research 3, no. 2 (2022): 001–4. http://dx.doi.org/10.53294/ijfstr.2022.3.2.0052.
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Hypertrophic scars can occur anywhere on skin after a skin injury or wound. The reason is not fully understood, the result is the abnormal production of extra collagen and a decrease in elastin, which lead to these undesirable thick, raised stiff scars. Sometimes surgery is performed to cut out the scar or redirect the lines of tension on the scar. Usually, surgery is considered when other treatment options have failed. Dermacell is human acellular matrix (hADM) that is intended for supplemental support and covering for soft tissue repair. It acts as ECM. The expression and proliferation of extracellular matrix (ECM) molecules in the dermis, mediated by a range of growth factors and cytokines, is a fundamental element of wound repair.
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Menezes, Carlos C. E., Tara Vantoai, Miller B. McDonald, and Tocio Sediyama. "Sequence-characterized amplified region (SCAR) technique used for variety discrimination in vinca (Catharanthus roseus (L.) G.Don)." Revista Brasileira de Sementes 24, no. 1 (2002): 299–305. http://dx.doi.org/10.1590/s0101-31222002000100041.
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Sequence-Characterized Amplified Region (SCAR) appears as a useful technique for genetic purity testing and variety discrimination, applicable to species in which some other techniques have failed. In particular, this technique is very attractive with species in which RAPD results were not consistent. The RAPD polymorphic bands were cloned, sequenced and from the sequence information, primers pairs for normal PCR were developed. Since the probability of obtaining successful SCAR primers from RAPD polymorphic bands was about 50%, a larger number of RAPD polymorphic bands are needed to develop sufficient SCAR primers for varietal discrimination in vinca. In addition, the efficiency of the SCAR technique is strongly affected by the quality of DNA extracted from seeds. The SCAR banding patterns obtained from vinca seed were consistent and repeatable making the results reliable for genetic purity testing and variety discrimination. The SCAR technique is simple, fast, relatively inexpensive and allows the use of DNA extracted from dry seeds, which is very important in a seed-quality evaluating program
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Ellis, James S., Daniel J. Paull, Sumit Dhingra, et al. "Growth Factors and Ocular Scarring." European Ophthalmic Review 03, no. 02 (2009): 58. http://dx.doi.org/10.17925/eor.2009.03.02.58.
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Growth factors play a part in every stage of the wound healing process that leads to scar tissue formation. Ocular scarring can cause decreased vision or blindness by virtue of the opaque nature of the new matrix that is deposited as scar tissue (as in the lens or cornea). In addition, the contractile nature of the ocular scar tissue is the most common cause of failed retinal attachment. Scar formation after glaucoma surgery can lead to surgery failure. Growth factors, particularly the transforming growth factor (TGF-βs), play a major role in scar tissue formation in the eye and induce the synthesis of growth factors that control cell migration, proliferation, enzyme production and matrix deposition. Neurotrophins are also neuroprotective and can delay ganglion cell death, thus delaying scar formation in the retina if retinal attachment is restored promptly. Growth factors can be seen as a major target for preventing ocular scarring in the future.
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Koh, Krystal, Devendra Kanagalingam, and Rajeswari Kathirvel. "A Rare Case of Watery Vaginal Discharge due to Caesarean Scar Dehiscence following Brace Suture and Balloon Tamponade for the Management of Postpartum Hemorrhage." Case Reports in Obstetrics and Gynecology 2020 (February 27, 2020): 1–4. http://dx.doi.org/10.1155/2020/2064782.
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A woman in her early twenties with dichorionic diamniotic twins underwent emergency caesarean section (CS) for failed induction of labor for discordant growth at 37 weeks. Her CS was complicated by atonic postpartum hemorrhage (PPH) requiring uterotonics, B-lynch suture, and Bakri balloon. She presented on the 5th postoperative day (POD) with fever and wound pain and collapsed due to desaturation. Investigations confirmed ascites on computed tomography (CT) of her abdomen and cardiomyopathy on echocardiogram. She was readmitted on the 22nd POD with watery vaginal discharge. CT abdomen revealed a dehisced CS scar and loculated ascites. Her discharge settled after three weeks with antibiotics and drainage of the ascites. A CT scan 3 months later showed reduction of the peritoneal collection. Caesarean scar dehiscence should be considered for patients presenting with ascites and vaginal discharge after a CS, particularly in the presence of risk factors such as infection or anemia.
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Fauzia Fatima, Mardi Osman, and Farah Nadia Sheikh. "CASE OF SCAR PREGNANCY MISDIAGNOSED FIRST AS INEVITABLE MISCARRIAGE." Pakistan Journal of Science 75, no. 03 (2023): 621–22. http://dx.doi.org/10.57041/pjs.v75i03.1017.
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This abstract is about scar pregnancy case which was initially misdiagnosed as a case of inevitable miscarriage. Our patient g3 p1+1 presents in ERE as 7 weeks pregnancy with mild bleeding p/v. she was previous 1 LSCS. After scan and per speculum examination diagnosed as inevitable miscarriage as RPOCS was seen protruding through internal os on speculum examination. Patient was admitted for misoprostol as advised by consultant. Patient did not abort after Misoprostol. Consultant advised for evacuation under general anesthesia. As soon as registrar tried to hold RPPOCS with sponge holder patient started bleeding heavily. Registrar abandoned the procedure and called consultant on call. Consultant first tried to stop bleeding by compression methods but failed, so diagnosis of scar pregnancy with possible perforation was made and laparotomy started and RPOCS removed from scar and uterus closed in layers. Hemostasis secured with difficulty bilateral tubal ligation done, vasopressin given and vertical compression sutures applied. (GTG NO 21 / 2016 NICE clinical guideline 154. Manchester: NICE; 2012). Abdomen closed in layers. In ward 2 units of packed RBCS transfused. Patient discharged in stable condition on second postoperative day.
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Maki, Masayuki. "Development of SCAR markers for sex determination in the dioecious shrub Aucuba japonica (Cornaceae)." Genome 52, no. 3 (2009): 231–37. http://dx.doi.org/10.1139/g08-120.
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Two sex-linked fragments were identified by RAPD analyses in the dioecious diploid shrub Aucuba japonica var. ovoidea and were converted into markers of male-specific sequence characterized amplified region (SCAR) markers. PCRs using the primers designed in this study correctly discriminated 24 flowering males and 24 flowering females at higher annealing temperatures (SCAR markers OPA10-424 at 55 °C and OPN11-1095 at 65 °C), although at relatively low annealing temperatures, the fragments were amplified in both males and females. These SCAR primers were also tested to see whether they were applicable to sex identification in the conspecific tetraploid Aucuba japonica var. japonica. One set pf SCAR primers could be used for sex identification even in this tetraploid variety, although the other failed. The SCAR markers developed in this study will provide a powerful tool in identifying the sex of immature plants of dioecious A. japonica, which is a commercially valuable shrub due to its conspicuous fruits.
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S., Siwach, Lakra P., Sangwan V., Shivani, Kansal R., and Mahendru R. "To study the outcome of previous one cesarean pregnancies in a rural tertiary center of Haryana, India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 11 (2017): 5008. http://dx.doi.org/10.18203/2320-1770.ijrcog20175017.
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Background: Rising rates of caesarean section is a matter of great concern and TOLAC is an attractive alternative. Analysing outcome of previous one caesarean pregnancies will provide an insight for reducing the caesarean rates and formulating protocols and policies for TOLAC.Methods: A retrospective study of patients of previous one caesarean pregnancy was done from February 2015 to January 2016 and 3 groups were made, ERCS group, failed TOLAC group and successful TOLAC group. The rates of elective repeat caesarean, failed TOLAC, successful TOLAC, maternal complications, neonatal morbidity and mortality in all three groups were studied.Results: There were 5177 total deliveries with 488 (9.43%) previous one caesarean pregnancies. Out of 488 patients 161 (33%) underwent elective repeat caesarean and 327 (67%) underwent trial of labour. Out of 327 patients 234 (71.56%) had a successful TOLAC and 93 (28.44%) had failed TOLAC. Breech (23%) followed by foetal distress (20%) were the most common indications of previous caesarean. Commonest indication of elective repeat caesarean was short interval (33%) and that of failed TOLAC was foetal distress (38.7%) followed by failed induction (23.6%). There were 4 morbidly adherent placentas (0.82%), 1 scar rupture, 3 scar dehiscence, no maternal mortality and 10 neonatal deaths.Conclusions: Previous one caesarean section is not only a risk factor for repeat caesareans and complications like morbidly adherent placenta, uterine rupture but also a financial burden on health facilities. Encouraging the patients for trial of labour and emphasizing the usage of contraception is the need of the hour.
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Mehren, Christoph, Lorenz Wanke-Jellinek, and Andreas Korge. "Revision after failed discectomy." European Spine Journal 29, S1 (2019): 14–21. http://dx.doi.org/10.1007/s00586-019-06194-9.
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Abstract Purpose Recurrent lumbar disc herniation is the most common complication after discectomy. Due to the altered anatomy with the presence of scar tissue, the surgical revision of already operated patients could be a surgical challenge. Methods We describe the microsurgical revision technique step by step with the evaluation of our own clinical results in comparison with primary lumbar disc surgeries. The clinical data are based on a clinical register with 2576 recorded primary surgeries (PD) and 592 cases of revisions (RD) with 12- and 24-month follow-up (FU). The intraoperative dura lesion rates of the surgeries between 2016 and 2018 were recorded retrospectively. Data from 894 primary disc surgeries and 117 revisions were evaluated. Results The ODI and the VAS for leg and back pain improved in both groups significantly with slightly inferior outcome of the revision group. The ODI improved from 46.3 (PD) and 45.9 (RD), respectively, to 12.6 (PD) and 22.9 (RD) at the 24-month FU. The VAS dropped down as well in both group [VAS back: 47.8 (PD) and 43.9 (RD) to 19.9 and 32.2 at the 24-month FU; VAS leg: 62.9 (PD) and 65.5 (RD) to 15.6 and 26.8 at the 24-month FU]. During the primary interventions, we observed 1.5% (11/894) and during revisions 7.7% (9/117) of dura lesions. Conclusions There is no clear guideline for the surgical treatment of recurrent disc herniations. In most cases, a pure re-discectomy is sufficient and can be performed safely and effectively with the help of a microscope. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.
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Kuppulakshmi, G., and S. Saranya. "Trial of scar in post caesarean pregnancies." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 3 (2018): 1173. http://dx.doi.org/10.18203/2320-1770.ijrcog20180913.
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Background: The term caesarean delivery used to describe the delivery of a fetus through a surgical incision of the intact anterior uterine wall. The objective of this study was to analyse the maternal and perinatal morbidity between successful VBAC and failed vaginal delivery in cases selected for trial of labour.Methods: Prospective study conducted in Government RSRM Lying In Hospital, Government Stanley Medical College, Chennai over a period of one year from January 2017 to December 2017.Results: Trial of labour in previous caesarean section was more successful when the interval between previous caesarean and present pregnancy was between two to four years 86.40%. Conclusions: Most patients with a prior caesarean birth are candidates for VBAC. In properly selected women, a trial of labour after one previous low transverse caesarean section constitutes the best and safest form of obstetric management.
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Parmar, Gautam, Samrat Chatterjee, Neha Kapur, et al. "Trends in keratoplasty from central and Northern India. Part I: Indications for keratoplasty." Indian Journal of Ophthalmology 72, no. 1 (2023): 87–93. http://dx.doi.org/10.4103/ijo.ijo_721_23.
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Purpose: To report the indications for keratoplasty and analyze trends in two decades in India. Methods: This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and northern India from 2005 to 2021. The patterns of corneal pathology and changes in trends were analyzed. Results: Between 2005 and 2021, 13223 corneal grafts were performed in the six collaborating tertiary eye care centers. The most common indication for keratoplasty in both decades was corneal ulcer (41.1%), followed by corneal scar (25.5%), failed graft (12.0%), post-cataract surgery corneal edema (11.7%), corneal dystrophies (3.1%), corneal ectasia (1.8%), corneal trauma (0.3%), congenital corneal opacity (0.3%), and others (4.1%). An increasing trend was seen in corneal ulcers, failed grafts, and keratoconus. A reducing trend was seen in corneal scar and aphakic bullous keratopathy. There was no change in pseudophakic bullous keratopathy and Fuchs endothelial corneal dystrophy. Conclusion: Corneal ulcers, corneal scars, failed grafts, and post-cataract surgery corneal edema remained the foremost indications for keratoplasty in two decades in India. An increasing trend was seen in corneal ulcers and failed grafts which are of concern as these indications carry a poorer outcome. Capacity building in lamellar keratoplasty techniques is the need of the hour as pseudophakic bullous keratopathy was an important indication, and an increasing trend was noticed in keratoconus.
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Sengupta Dhar, Rinku, and Renu Misra. "Postpartum Uterine Wound Dehiscence Leading to Secondary PPH: Unusual Sequelae." Case Reports in Obstetrics and Gynecology 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/154685.
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Secondary postpartum haemorrhage due to partial or complete dehiscence of uterine wound after caesarean section is unusual. Authors present here a patient with secondary postpartum haemorrhage following uterine dehiscence after caesarean delivery. Conservative management failed to control the bleeding, and she eventually needed hysterectomy. All women who have significant PPH following caesarean should undergo evaluation for any defect in the scar. Scar dehiscence has been diagnosed and repaired after many years of caesarean section in women with persistent abnormal bleeding. Therefore, this condition may have long-term implication if missed postpartum.
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Ye, Ren, Weixia Wang, and Jie Li. "Analysis of high risk factors for complications in the trial of vaginal delivery due to uterine scarring in a subsequent pregnancy to a cesarean section." Investigación Clínica 63, no. 3 (2022): 235–42. http://dx.doi.org/10.54817/ic.v63n3a03.
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The purpose of this work was to analyze the high-risk factors of com-plications in the trial of vaginal delivery of a subsequent pregnancy for scar uterus after a previous cesarean. 136 pregnant women with scar uterus with a history of cesarean who were admitted to our obstetrics department from February 2016 to March 2019 were selected and were divided into a successful group and a failed group according to the results of pregnancy and trial of labor vaginal delivery. Gen-eral data of before, during, and after delivery were collected and the high-risk fac-tors for failed vaginal delivery of scar uterine were analyzed by the logistic regression analysis.Among the 136 patients, 108 cases (79.41%) of vaginal trials were success-ful, and 28 cases (20.59%) of vaginal trials faired.The univariate analysis showed that the differences in gravidity, parity and the previous cesarean interval, vaginal birth history, prenatal BMI, uterine contraction, gestational age, infant weight, dila-tation of the cervix, cervical Bishop score, the height of the fetal head, the thickness of the lower uterus, and whether the membranes were prematurely ruptured were statistically significant (P<0.05). Logistic regression analysis showed vaginal birth history, prenatal BMI ≥ 30 kg/m2, parity ≥ 2 times, cesarean interval <2 times, dilatation of cervix ≥ 1 cm, the height of the fetal head ≥ -3, premature rupture of the membrane and the thickness of the lower uterus of 3.0 to 3.9 cm were the high-risk factors of complications in the vaginal trial delivery of pregnancy again for scar uterus (P<0.05). It is feasible for pregnant women with scar uterus to undergo vaginal delivery, but many related factors can affect the failure of trial of labor. It is necessary to pay attention to all aspects of clinical examination and choose applica-tions strictly according to the indications.
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Job, Angeline, and Spandana S. "Successful term pregnancy after uterine artery embolization for caesarean scar ectopic pregnancy: a case report." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 9 (2018): 3877. http://dx.doi.org/10.18203/2320-1770.ijrcog20183812.
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The incidence of caesarean scar pregnancy range from 1 in 1800 to 1 in 2500 of all pregnancies. It has been estimated that 6.1% of pregnancies in women with at least one previous Caesarean section and a diagnosis of ectopic pregnancy will be Caesarean scar pregnancy (CSP). There is no consensus on the management of CSP. An invasive intervention such as excision of scar ectopic can reduce recurrence but affects patient’s fertility. Conservative management like administration of methotrexate and uterine artery embolization (UAE) is specially important for young women who want to keep their fertility. This is a case report of a 29-year-old woman who presented with persistent heavy bleeding following failed MTP at 12 weeks of gestation. Ultrasonogarphy was suggestive of Caesarean scar pregnancy and MRI of chronic left adnexal ectopic. Laparotomy also was suggestive of Caesarean scar ectopic. She was managed conservatively with UAE followed by Methotrexate. The procedure was performed successfully, and the patient’s fertility was preserved. Follow up consisted of serial bhCG monitoring which gradually returned to normal levels. She conceived four years after UAE and had an uneventful antenatal period and underwent Elective Cesaraen section at 38 weeks. For those patients with CSP who desire future pregnancy, the comprehensive treatment including UAE can be considered in management.
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Dhansuya Thangavel, Thillaikkarasi A, Narasimhalu C R V, Sathyanarayanan R, and Sridevi. "Dermatofibroma Over The Scar – A Rare Entity." International Journal of Research in Pharmaceutical Sciences 11, SPL4 (2020): 1502–4. http://dx.doi.org/10.26452/ijrps.v11ispl4.4330.
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Dermatofibroma is a common benign dermal tumour of unknown aetiology. With varied clinical presentation mimicking keloid, desmoid tumour and leiomyoma, the diagnosis of Dermatofibroma sometimes become problematic from the clinician side. Here, we report a case of Dermatofibroma in a not so common site which was clinically diagnosed to be a keloid. But later, the lesion turned out to be a dermatofibroma on histopathological examination. In our patient, the lesion was a single smooth circumscribed nodule over the left side of the abdomen. The lesion had a linear scar on either side and on palpation; it was firm in consistency. It was initially diagnosed to be a keloid which even after multiple intra-lesional steroid injections, failed to show any results. This prompted us to search for an alternate diagnosis; hence lesion was excised and analyzed. The Histopathological examination revealed a circumscribed lesion in the dermis, composed of benign spindle-shaped cells arranged in a storiform pattern. These findings, as mentioned above, were consistent with a diagnosis of Dermatofibroma, which is a slow-growing tumour commonly seen in the extremities. The keloid like a presentation of Dermatofibroma, is one another example of how a similar morphological presentation may have two distinct diagnoses resulting in a delay in providing appropriate treatment.
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Kim, Jin, Theodore Smith, Neeraja Idamakanti, et al. "Targeting Adenoviral Vectors by Using the Extracellular Domain of the Coxsackie-Adenovirus Receptor: Improved Potency via Trimerization." Journal of Virology 76, no. 4 (2002): 1892–903. http://dx.doi.org/10.1128/jvi.76.4.1892-1903.2002.
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ABSTRACT Adenovirus binds to mammalian cells via interaction of fiber with the coxsackie-adenovirus receptor (CAR). Redirecting adenoviral vectors to enter target cells via new receptors has the advantage of increasing the efficiency of gene delivery and reducing nonspecific transduction of untargeted tissues. In an attempt to reach this goal, we have produced bifunctional molecules with soluble CAR (sCAR), which is the extracellular domain of CAR fused to peptide-targeting ligands. Two peptide-targeting ligands have been evaluated: a cyclic RGD peptide (cRGD) and the receptor-binding domain of apolipoprotein E (ApoE). Human diploid fibroblasts (HDF) are poorly transduced by adenovirus due to a lack of CAR on the surface. Addition of the sCAR-cRGD or sCAR-ApoE targeting protein to adenovirus redirected binding to the appropriate receptor on HDF. However, a large excess of the monomeric protein was needed for maximal transduction, indicating a suboptimal interaction. To improve interaction of sCAR with the fiber knob, an isoleucine GCN4 trimerization domain was introduced, and trimerization was verified by cross-linking analysis. Trimerized sCAR proteins were significantly better at interacting with fiber and inhibiting binding to HeLa cells. Trimeric sCAR proteins containing cRGD and ApoE were more efficient at transducing HDF in vitro than the monomeric proteins. In addition, the trimerized sCAR protein without targeting ligands efficiently blocked liver gene transfer in normal C57BL/6 mice. However, addition of either ligand failed to retarget the liver in vivo. One explanation may be the large complex size, which serves to decrease the bioavailability of the trimeric sCAR-adenovirus complexes. In summary, we have demonstrated that trimerization of sCAR proteins can significantly improve the potency of this targeting approach in altering vector tropism in vitro and allow the efficient blocking of liver gene transfer in vivo.
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Baranello, Robert, Jeremy Walker, and Christopher Sobey. "A Retrospective Case Series of Difficult Percutaneous Dorsal Column Stimulator Epidural Lead Placement for Failed Back Surgery Syndrome." Pain Medicine Case Reports 5, no. 6 (2021): 325–31. http://dx.doi.org/10.36076/pmcr.2021.5.325.
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BACKGROUND: Percutaneous dorsal column stimulator lead placement is a well-established procedure for a variety of neuropathic disease processes, including failed back surgery syndrome (FBSS). Although previous spine surgeries and patient-specific pathology can make lead placement difficult, there are very few studies or case reports documented in the literature describing these challenges and outcomes. CASE REPORT: A retrospective electronic medical record chart review was conducted of 6 patients with FBSS who failed more conservative interventional therapies and otherwise multimodal analgesia as deemed by both patient and practitioner. CONCLUSION: Postsurgical changes in the epidural space, including fibrosis and scar tissue formation, made driving leads very challenging and compromised final lead placement as well as number of leads placed. KEY WORDS: Neuromodulation, failed back surgery syndrome, dorsal column stimulation
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Samad, Shaikh Abdus, Nahum Antony, and Zeeshan Ali. "Case Report on the Outcome of the Scheduled Exercise and Manual Physiotherapy on A Male Patient with Failed Neck Surgery Syndrome." International Journal of Physiotherapy Research and Clinical Practice 2, no. 4 (2023): 10–14. http://dx.doi.org/10.54839/ijprcp.v2i4.23.3.
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Pain and discomfort after spinal surgery are known as "Failed Back Surgery Syndrome (FBSS)" and "Failed Neck Surgery Syndrome (FNSS)," respectively. Understanding what triggers FBSS/FNSS is essential for treating it. Outcomes can be affected by preoperative symptoms, patient expectations, and previous surgeries. Imaging techniques including X-rays, CT scans, and MRIs help doctors diagnose physical problems. After surgical attempts have failed, conservative treatment is often suggested. A 34-year-old Indian man after cervical surgery had neuropathic neck discomfort. Scheduled exercise and manual physiotherapy completed the treatment. Manual therapy addressed scar tissue adhesions and nerve mobility, while exercise improved neck strength, flexibility, and stability. Twelve weeks of three-times-a-week treatment. Manual physiotherapy uses soft tissue mobilisation, myofascial release, joint mobilisation, and nerve gliding to alleviate neck pain and restore function. The patient's neck pain, mobility, and neuropathic symptoms improved over twelve weeks after the intervention. The intervention also improved the group's flexibility, mobility, and pain management, as seen by a greater range of motion, decreased discomfort, and higher pressure pain threshold. Balance increased as well. NDI scores showed little improvement after the intervention. Moreover, the intervention improved physical performance, pain management, and balance, however further research could address neck impairment elements not addressed by the intervention (Table 1). A 34-year-old Indian guy with a history of cervical surgery was cured of chronic neuropathic neck pain after 12 weeks of exercise and manual physiotherapy. Manual treatment targeted scar tissue and nerve movement, while exercise relieved neck pain and mobility. Keywords: Failed Back Surgery Syndrome (FBSS)”, Cervical Surgery, Neuropathic Symptoms, Neck Pain
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Koo, Hee Tae, and Ung Sik Jin. "The Effect of Stromal Vascular Fraction on Scar Formation of Transverse Rectus Abdominis Muscle Flap Donor Sites: A Pilot Study." Journal of Wound Management and Research 18, no. 1 (2022): 1–10. http://dx.doi.org/10.22467/jwmr.2021.01774.
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Background: Stromal vascular fraction (SVF), which plays a substantial role in wound healing, has been discussed in many recent studies concerning its positive effect on scar formation. Our study explored the effects of SVF on scar formation from partially-removed transverse rectus abdominis muscle (TRAM) flaps after inset.Methods: From December 2017 to May 2020, we enrolled 11 patients undergoing breast reconstruction performed by a single surgeon using the free TRAM flap. As a split-body, placebo-controlled study, SVF was subcutaneously injected into one side of the abdomen, and normal saline was injected into the other side of each patient. Scarring was evaluated using the Vancouver Scar Scale (VSS) and Patient Scar Assessment Questionnaire (PSAQ) at 1, 6, and 12 months after surgery, and histology was evaluated with immunofluorescence analysis at 6 months after surgery.Results: No statistically significant differences were noted in the total scores or subcategory score of the VSS and PSAQ between the test and control groups. Some patients showed more positive staining for alpha smooth muscle actin, collagen type I, and type III in the test group than in the control group. However, quantification of positively stained areas showed no statistically significant difference.Conclusion: Intraoperative SVF injection had no demonstrable clinical effect on scar quality. Histology with immunofluorescence analysis also failed to demonstrate any significant effect of SVF on scars at the microscopic level. Despite previous studies indicating the positive effects of SVF on scar quality, this pilot study questions its true effectiveness.
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Atobiloye, N., N. Cohen, R. S. Kim, and C. J. Ascher-Walsh. "8557 Laparoscopic Resection of Involuting Cesarean Scar Pregnancy after Failed Multidose Methotrexate and KCl Treatment." Journal of Minimally Invasive Gynecology 29, no. 11 (2022): S133. http://dx.doi.org/10.1016/j.jmig.2022.09.436.
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Fischer, L., S. M. Ludin, K. Puente de la Vega, and M. Sturzenegger. "Neuralgia of the Glossopharyngeal Nerve in a Patient with Posttonsillectomy Scarring: Recovery after Local Infiltration of Procaine—Case Report and Pathophysiologic Discussion." Case Reports in Neurological Medicine 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/560546.
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We describe a patient with a three-year history of severe progressive left-sided glossopharyngeal neuralgia (GPN) that failed to adequately respond to various drug therapies. The application of lidocaine spray to the posterior pharyngeal wall provided no more than short-term relief. Apart from a large hypertrophic tonsillectomy scar on the left side all clinical and radiologic findings were normal. In terms of therapeutic local anaesthesia, the hypertrophic tonsillectomy scar tissue was completely infiltrated with the local anaesthetic (LA) procaine 1%. The patient has been almost completely pain-free ever since, and the lidocaine spray is no longer needed. Six weeks after the first treatment a repeat infiltration of the tonsillectomy scar led to the complete resolution of all symptoms. The patient has become totally symptom-free without the need to take any medication now for two and a half years. This is the first report of a successful therapeutic infiltration of a tonsillectomy scar using an LA in a patient with GPN that has been refractory to medical treatment for several years. A possible explanation may be that the positive feedback loop maintaining neurogenic inflammation is disrupted and “sympathetically maintained pain” resolved by LA infiltration.
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Rashid, Beenish, Abida Ashraf, Mahpara Tariq, Abeera Choudry, Qurat ul Ain, and Hira Shafqat. "Maternal Morbidity Associated With A Successful Versus Failed Trial of Labour After A Previous Caesarean Section." Pakistan Armed Forces Medical Journal 74, no. 1 (2024): 226–28. http://dx.doi.org/10.51253/pafmj.v74i1.10282.
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Objective: To compare the maternal morbidity associated with a successful trial of labour after the previous scar versus a failed trial of labour after the previous scar and ending in repeat Caesarean section. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2022. Methodology: A total of six hundred and ten (n=610) patients were in the study. The variables studied while observing the outcome included indication of Caesarean section in the previous delivery, birth weight of the baby, overall outcome and post-operative maternal complications. Results: The mean age of the participating patients was 24.44±3.89 years. Of the 610 patients, 278(45.6%) delivered successfully via vaginal delivery after a previous Caesarean section, while 332(54.4%) had to be delivered again via repeated Caesarean section. Overall outcome in both groups revealed 331(99.7%) patients were delivered by Caesarean section, with 01(0.3%) patients landing in a ruptured uterus in the Caesarean Section Group. Conclusion: Previous history of normal vaginal delivery, increased parity and birth weight less than 3 kg have a better chance of a successful Vaginal Birth after a Caesarean section in selected patients resulting in fewer complications and decreasing the overall Caesarean section rate.
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Gardes, Johnathan, and Tracey Straker. "Impossible Airway Requiring Venovenous Bypass for Tracheostomy." Case Reports in Anesthesiology 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/592198.
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The elective surgical airway is the definitive management for a tracheal stenotic lesion that is not a candidate for tracheal resection, or who has failed multiple-tracheal dilations. This case report details the management of a patient who has failed an elective awake tracheostomy secondary to the inability to be intubated as well as severe scar tissue at the surgical site. A combination of regional anesthesia and venovenous bypass is used to facilitate the surgical airway management of this patient. Cerebral oximetry and a multidisciplinary team approach aid in early detection of an oxygenation issue, as well as the emergent intervention that preserved this patient’s life.
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Patil, Suma, and S. K. Patil. "Dermaroller: simple and effective acne scar treatment." International Journal of Research in Dermatology 2, no. 3 (2016): 46. http://dx.doi.org/10.18203/issn.2455-4529.intjresdermatol20163149.
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<p class="abstract"><strong>Background:</strong> Scarring is particularly a distressing phenomenon. The micro-needling is a minimally invasive procedure which has recently attained popularity because of the fact that it can be used safely with minimal training.</p><p class="abstract"><strong>Methods:</strong> The present study was performed on 30 patients suffering from facial scarring of acne vulgaris. The patients were photographed and assessed clinically at the time of enrolment to grade the severity of scarring as per the grading system proposed by Goodman and Baron.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 30 patients were included in the study of which females were 18 and males 12. The age of the patients ranged from 18 to 30 years with the mean age of 24 years. Overall, 20 out of the total of 28 patients (71.4%) showed an excellent response to dermaroller treatment while 7 others achieved a good response (25%). Only 1 patient (3.6%) out of the total of 28 failed to show a significant response to treatment.</p><p><strong>Conclusions:</strong> Dermaroller is a safe and effective treatment option for grade 2 and grade 3 acne scars.</p>
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Akanda, Marzia, Md Rabeul Karim, Reeva Aireen Busreea, et al. "Failed Medical Management of a Caesarean Scar Pregnancy Leading to Manual Vacuum Aspiration and Hysterotomy: A Case Report." Community Based Medical Journal 14, no. 1 (2025): 163–67. https://doi.org/10.3329/cbmj.v14i1.79357.
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Caesarean scar pregnancy (CSP) is a unique type of pregnancy that has been becoming more common due to the growing cesarean section rate. This case report is about a 36-year-old woman with Caesarean scar pregnancy who did not respond to medical management and later underwent successful surgery. The patient previously had two Caesarean section deliveries and three abortions; she was initially given two cycles of methotrexate. However, measurement of β-hCG titers and sonography established continuation of pregnancy at 9 weeks±3 days. Another attempt at medical management with misoprostol and mifepristone was also unsuccessful. Elevation of the β-hCG level was observed from 4165 mIU/mL to 33526 mIU/mL within a month, which was suggestive of a continuing pregnancy. Following those failed medical interventions, a manual vacuum aspiration (MVA) was also tried and failed. For further safety and wellbeing of the patient, hysterotomy under general anaesthesia was done. The case highlights several critical aspects of CSP management: monitoring in the form of serial β-hCG and ultrasound, the shortcomings of medical management, and the timing of the transition to surgery. The fact that performing MVA and hysterotomy after failed medical management signifies that healthcare settings should have more than one treatment options in such cases. Altogether, this paper adds to the number of studies on the management of CSP, highlighting tailored therapeutic methodologies and the importance of the follow-up period. It is the same way that it also poses a challenge regarding the timing of treatment intervention and stressing patient counsel on future pregnancy dangers after a cesarean section. CBMJ 2025 January: Vol. 14 No. 01 P: 163-167
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Singh, Vinita, Rajshree Sahu, Esha Das, and Pavan B. C. "A near miss case of placenta percreta in a patient with post myomectomy scar." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 12 (2019): 5062. http://dx.doi.org/10.18203/2320-1770.ijrcog20195373.
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The term placenta accreta or placenta accrete syndrome is used to describe a spectrum of an abnormal placental implantation and firm adherence which are classified according to the depth of invasion into the uterus. A 28-year-old elderly primigravida presented AIIMS OPD to for the 1st time at 13+2 weeks of gestation with brownish discharge per vaginum. Ultrasonography done showed 12 weeks single intrauterine pregnancy with subchorionic haemorrhage of 3.7×2.52 cm with placenta being fundoanterior. She underwent myomectomy 2 years back and during her antenatal care in 3rd trimester growth scan at 30+2 weeks of gestation placenta was fundoanterior with loss of retroplacental hypoechoic in the upper margin of placenta at the myomectomy scar site with small extra uterine collection seen measuring 7.6×2.3 cm and hence possibility of placenta accreta was suggestive by the above findings confirmed by MRI. Emergency cesarean section done at 36+6 weeks of gestation for leaking per vaginum. Manual removal of placenta was tried but it failed and soon atonic PPH developed. Seeing no response with uterotonics internal iliac artery ligation was also attempted but failed. Immediate decision for hysterectomy was taken as a life-saving method. On adhesiolysis in the fundal region placental tissue perforating uterine serosa was visible on the surface of uterus, hence diagnosis of placenta percreta was confirmed which was further confirmed on histopathological report. Currently hysterectomy or local resection is preferred over conservative management with methotrexate.
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Kovyda, N., and N. Honcharuk. "Ultrasound diagnosis conditions of the uterus scar in pregnant and non-pregnant women." HEALTH OF WOMAN, no. 9-10(155-156) (December 30, 2020): 39–43. http://dx.doi.org/10.15574/hw.2020.155-156.39.
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The dynamic increase in the number of caesarean section in Ukraine and around the world remains one of the main topics of discussion, which is intensively discussing by leading scientists. The traditional assessment of the ability of the uterus scar during pregnancy, based mainly on the analysis of clinical and anamnestic data, is not high informative, and the ambiguous conclusions of the sonographic study indicate the need for further detailed study. Therefore, there is reason to believe that the development of criteria for ultrasound assessment of the condition of the uterus scar after previous cesarean section will use them to predict the possibility of spontaneous delivery in the future and remains relevant. The objective: study the features of ultrasound diagnosis of the condition of the scar on the uterus in pregnant and non-pregnant women. Materials and methods. Observations and retrospective analysis of medical records of pregnant women and birth histories in 150 women with a scar on the uterus after a previous cesarean section for the period from 2014–2019. Results. In women who became pregnant up to a year after the previous cesarean section, the most pronounced changes in blood flow were in the uterine arteries, especially during gestation 28–34 weeks. Also, in women with a failed uterus scar, changes in blood flow were most often observed in the uterine arteries at all levels and were significantly higher, compared with women with a capable uterus scar and women from the control group. In women with an insolvent uterus scar, the most pronounced changes in the indices of vascular resistance was observed in the uterine arteries, in particular the right uterine artery. Conclusion. The peculiarities of blood flow and vascular resistance in different vessels of the myometrium depending on the gestation period and the timing of pregnancy after a previous cesarean section. The obtained detailed ultrasound examination and mathematical calculation of the results of ultrasound examination of the uterus and postoperative uterus scar after previous cesarean section in non-pregnant women allowed to create a scale for assessing the condition of the uterus scar after previous cesarean section in non-pregnant women. Keywords: cesarean section, uterus scar, ultrasound, pre-pregnancy preparation of women.
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Malik, M. F., L. R. Hoyos, J. Rodriguez-Kovacs, J. Gillum, and S. C. Johnson. "Placenta Increta Complicating Persistent Cesarean Scar Ectopic Pregnancy following Failed Excision with Subsequent Preterm Cesarean Hysterectomy." Case Reports in Obstetrics and Gynecology 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/4071840.
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Introduction.Cesarean scar pregnancies (CSPs) are one of the rarest forms of ectopic pregnancy. Given their rarity, there is lack of consensus regarding the management and natural course of CSPs.Case.A 37-year-old G10 P3063 female with a history of two prior cesarean deliveries was diagnosed with her second CSP at 6 weeks and 5 days in her tenth pregnancy. The patient underwent vertical hysterotomy, excision of a gestational sac implanted in the cesarean sac, and bilateral salpingectomy via a laparotomy incision. The histopathology report confirmed immature chorionic villi. The patient returned 10 weeks later and was found to be still pregnant. Obstetric ultrasound confirmed a viable fetus of 19 weeks and 4 days of gestational age with a thin endometrium and an anteroposterior and right lateral placenta with multiple placental lakes. The patient ruptured her membranes at 31 weeks of gestation and pelvic MRI revealed an anterior placenta invading the myometrium and extending to the external serosal surface consistent with placenta increta. Following obstetric interventions, a live female infant was delivered by cesarean hysterectomy (because of placenta increta) at 32 weeks of gestation.Conclusion.Development of standardized guidelines for management of CSPs, as well as heightened vigilance for possible complications, is required for proper care and avoidance of potential morbidity and mortality.
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Oseira-Reigosa, Anaí, José Antonio Martínez-Córcoles, and Alberto Pagán-Pomar. "TORACOSCOPIA EN PRONO URGENTE: UNA OPCIÓN PARA EL TRATAMIENTO DE LA PERFORACIÓN ESOFÁGICA POR CUERPO EXTRAÑO." Annals of Mediterranean Surgery 8, no. 1 (2025): 43–44. https://doi.org/10.22307/2603.8706.2025.01.009.
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A 53-year-old man swallowed a dental prosthesis that caused odynophagia and dysphagia. Failed endoscopic attempts led to a diagnosis of esophageal perforation with paraesophageal collection. Urgent prone thoracoscopy removed the prosthesis, repaired the defect, and included esophageal exclusion and jejunostomy. He was discharged after 18 days, with scar stenosis managed by endoscopic dilation three months later. Prone thoracoscopy provides effective, minimally invasive treatment for complex esophageal perforations, preserving the esophagus and minimizing complications.
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Abihssira, Sharon, Victor Housset, Malo Le Hanneur, and Geoffroy Nourissat. "Management of Failed Latarjet Procedure Using a Distal Clavicular Autograft." Video Journal of Sports Medicine 2, no. 4 (2022): 263502542210999. http://dx.doi.org/10.1177/26350254221099954.
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Background: Latarjet procedure is the gold standard surgery in cases of shoulder instability with substantial bone loss. Recurrence is scarce but its management may be challenging. Numerous revision techniques, based on soft tissue repairs with autograft or allograft augmentations, have been developed. Autografts are associated with potential donor-site morbidity while allografts may generate additional costs. We present here the use of the ipsilateral distal clavicular osteochondral autograft in the setting of failed Latarjet procedure. Indication: The indication is a failed coracoid bone block procedure with recurrent instability and preoperative imaging demonstrating intact acromioclavicular (AC) joint with preserved coracoclavicular (CC) ligaments. This technique should not be used if there was a previous lesion of the CC ligaments during coracoid harvest. Technique Description: A delto-pectoral approach is used and extended superiorly to access the distal clavicle end as well as the glenohumeral (GH) joint anterior aspect. A distal clavicular osteochondral autograft is harvested with an oscillating saw after identifying the AC joint with a needle to prevent any resection medial to the CC ligament insertions, which would compromise distal clavicle stability. The GH joint anterior aspect is exposed, similar to the Latarjet procedure, to first remove the coracoid graft remnants along with any scar tissues surrounding the joint anterior aspect. Distal clavicular autograft is predrilled and fixed to the scapula using 2 cortical screws. The clavicular articular surface may be used to replace the glenoid cartilage defect. In this case, the anatomy of the distal clavicle did not allow us to perform such articular replacement. Results: Return to daily activities was authorized after 3 weeks postoperatively. After 6 weeks, shoulder pain lowered and no clavicle instability or donor-site complication was reported. Return to sport is expected in 50% of cases, compared with other revision procedures. Computed tomography (CT) scan showed an adequate positioning of the bone block and its fusion at 3 months postoperatively. Conclusion: In the setting of a failed Latarjet procedure with recurrent shoulder instability, distal clavicular autograft appears to be a reliable option to reduce donor-site morbidity and avoid additional costs. A prospective clinical study is needed to evaluate this technique in the long term.
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Ganapathi, Trupthi, and Hemangi K. Chaudhari. "Ultrasonographic measurement of uterine lower segment scar thickness in cases of previous one caesarean section and obstetric outcome." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 11 (2018): 4454. http://dx.doi.org/10.18203/2320-1770.ijrcog20184488.
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Background: Vaginal birth after caesarean section (VBAC) has become an integral part of modern obstetrics with more than 1lakh VBACs achieved each year nationwide. Several studies have reported perinatal risks associated with failed trial of labour and uterine rupture in women attempting VBAC, due to concerns about these complications, the rate of VBAC deliveries has continued to fall in developed countries, with an inverse increase in Caesarean Sections (CS). To better assess the risk of uterine rupture, many authors have proposed sonographic measurement of scar or lower uterine segment (LUS) thickness near term, assuming that there is an inverse correlation between LUS thickness and the risk of uterine scar defect. Therefore, this assessment for the management of women with prior CS has increased safety by selecting women with the lowest risk of uterine rupture.Methods: Present study was a prospective observational study which assessed the obstetric outcome in women with previous lower segment caesarean section willing for trial of labour. Secondly, authors aimed to ascertain the best cut off values for predicting uterine rupture.Results: Present study found that as duration between previous LSCS and next pregnancy increased there was better chance of VBAC. As the baby weight increased VBAC rate reduced. Study also showed that scar thickness of 2.55mm and above measured by transabdominal method in the third trimester can be safely given trial of VBAC.Conclusions: Authors thus conclude that measurement of lower uterine segment/ scar thickness can help obstetrician decide whether VBAC is safe or not in patients with previous one LSCS willing for VBAC. Scar thickness of more than 2.55mm can be given safe trial of labour in women with previous one lower segment caesarean section.
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Brichacek, Michal, Babar Sultan, Kofi D. Boahene, Lisa Ishii, and Patrick J. Byrne. "Objective Outcomes of Minimally Invasive Temporalis Tendon Transfer for Prolonged Complete Facial Paralysis." Plastic Surgery 25, no. 3 (2017): 200–210. http://dx.doi.org/10.1177/2292550317728033.
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Objectives: We describe an approach to reanimation of complete, prolonged facial paralysis using minimally invasive temporalis tendon transfer (MIT3) by the melolabial or transoral approach. Objective outcome measures are evaluated based on symmetry, and grading of preoperative/post-operative results and the scar at the melolabial fold. Study Design: Retrospective cohort study. Methods: Twenty-five patients undergoing the MIT3 technique were studied. Photographic analysis was used to determine the percentage of difference between the 2 sides (symmetry). Using the Delphi method to achieve consensus, a panel of experts graded pre/post-operative photos using the Terzis’ Facial Grading System and a 1 to 10 Likert-type scale and the melolabial scar using the Beausang Scar Scale. Results: Percentage of difference (symmetry) with smiling improved from 18.6% ± 1.5% (mean ± standard error of the mean [SEM]) preoperatively to 5.0 ± 0.9% (mean ± SEM) post-operatively. Expert grading by the Terzis system showed improvement post-operatively (mean 3.7/5; median 3.6/5) versus preoperatively (mean 1.5/5; median 1.2/5). Perceived improvement was also largely favourable (mean 8.1/10; median 8.0/10). Melolabial scar grading was favourable in terms of colour (mean 1.53/4), surface character (mean 1.05/2), contour (mean 1.60/4), and distortion (mean 1.74/4). Conclusions: The MIT3 technique offers immediate, predictable, and symmetrical return of smile function. Objective symmetry analysis and favourable expert grading of both pre-/post-operative photographs and the scar at the melolabial fold demonstrate applicability for facial reanimation in patients where other procedures have failed, or when a direct return to function is desired. Both the melolabial approach and transoral approach were found to be acceptable and effective, although applicability varies.
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Adela, Siti. "Iran Hostage Crisis: A Sphere Full of Distrust and Failure." Jurnal Sentris 1, no. 1 (2020): 31–41. http://dx.doi.org/10.26593/sentris.v1i1.4126.31-41.
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There is no doubt that Iran hostage crisis has left quite a profound scar in U.S. history. It also signaled the inability of U.S. government, through President Jimmy Carter, to solve the problem that U.S. faced in the past. This paper delves into the brief history of the diplomatic crisis that happened between U.S. and Iran, also it stressed on how Carter tried to engage Iran in several warm negotiations, including the so-called ‘failed’ mission, which were mostly greeted by refusal from Iran itself
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Zhao, Lingzhou, Yuan Gao, Yihan Xiao, Xinwei Tan, Xiaochen Li, and Tianzheng Deng. "Treatment of Advanced Gingival Recession Secondary to Surgical Failure with Large Size Deepithelized Gingival Graft Associated with a Modified Tunnel Flap." Case Reports in Dentistry 2023 (September 19, 2023): 1–8. http://dx.doi.org/10.1155/2023/8954257.
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Objective. To describe the use of a large size deepithelized gingival graft (DGG) associated with full-split tunnel technique in a clinical case of advanced gingival recession secondary to surgical failure (GRSF). Clinical Considerations. The presented case report helped to achieve satisfactory root coverage, ideal keratinized tissue gain, improvement in soft tissue quality and esthetics, scar deformity correction, and vestibular depth deepening with a one-step procedure of large size DGG associated with full-split tunnel technique for a condition of deep gingival recessions of 7-11 mm caused by a failed bone implantation surgery. Conclusions. The large size DGG associated with full-split tunnel technique provided a versatile one-step procedure to obtain ideal results for advanced GRSF. Clinical Significance. GRSF that is generally associated with inadequate keratinized tissue and scar formation could be rather difficult to deal with. The large size DGG associated with full-split tunnel technique, as a one-step procedure, provided a predictable and practical treatment modality.
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Kaur, Harpreet, Muskan Aggarwal, Sarvjeet Kaur, et al. "Evaluation of outcome of medical and surgical management in cesarean scar pregnancy in a tertiary health care institute of Northen India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 13, no. 10 (2024): 2891–99. http://dx.doi.org/10.18203/2320-1770.ijrcog20242828.
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A rare form of ectopic pregnancy known as caesarean scar pregnancy (CSP) is associated with high rates of morbidity and mortality. When a growing conceptus is pathologically implanted into the site of a prior caesarean section, CSP ensues. Transvaginal ultrasonography (TVS) and transabdominal ultrasound are the main diagnostic methods for CSP. It was a series of clinical cases diagnosed over a period of 1 year. The clinical characteristics included in the study were maternal age, gravidity, number of prior caesarean sections, number of abortions, interval between CSP and caesarean sections, gestational age, mean size of the residual gestational tissue before intervention, serum β-hCG levels before and after intervention. All cases were detected timely in the first trimester itself on USG evaluation. Amongst all cases, ß hCG levels at the time of admission varied between 266 mIU/ml-56,265 mIU/ml. 30% patients were treated with medical management only with inj. methotrexate and inj. folinic acid out of which 60% of cases had failed medical management and had to undergo further surgical procedure. 30% of cases with failed medical management were planned for hysteroscopic curettage, 20% underwent dilatation and curettage (D and C) while only 1 patient who was diagnosed with early placenta accreta required hysterectomy. CSP is a rare yet life threatening obstetric condition. Medical management should be used as the first line of treatment in patients with hemodynamic stability. Laparotomy and embolization are invasive procedures that should only be used in patients with failed medical management or patients with severe bleeding.
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Hsieh, Ching-Hua, Ko-Chien Lin, Shao-Chun Wu, et al. "Facilitated delivery of topical steroids after fractional ablative carbon dioxide laser failed to prevent the postthyroidectomy hypertrophic scar." Dermatologica Sinica 39, no. 3 (2021): 118. http://dx.doi.org/10.4103/ds.ds_29_21.
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Bajracharya, Leena. "Outcome of Optical Keratoplasty for Corneal Scar due to Infective Keratitis." Nepalese Journal of Ophthalmology 15, no. 1 (2023): 61–67. http://dx.doi.org/10.3126/nepjoph.v15i1.40632.
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Introduction: Corneal opacity is an important cause of blindness in developing countries. Objectives: This study analyzes optical keratoplasty performed for corneal opacity due to infective keratitis. Materials and methods: This is a retrospective study of all consecutive cases of optical keratoplasty performed between 2011 and 2014 (four-year period) for healed infective keratitis. Cases with less than two months’ followup were excluded during outcome evaluation. Comparison was made between keratoplasty for Microbial and Viral (herpetic) Scar. Results: Ninety-three eyes of 93 patients were enrolled. Fifty-nine (63.4%) were male. Average age of patients was 38.9±19.5 years. Average donor endothelial cell count was 2713±434.5 cells/mm2. Fifty-four (58%) corneal scars were due to microbial keratitis and others were herpetic. Eighty-five (91.4%) had undergone penetrating keratoplasty. Eighty-eight (94.6%) cases were included for outcome analysis. Average follow-up duration was 37±27.5 months. Fifty-two (59%) had clear graft at their last visit. Twenty-three (26.1%) grafts had endothelial failure and 13 (14.7%) grafts failed due to late onset keratitis. Twenty-five (28.4%) had vision of ≥6/18. Rejection occurred in 24(27.2%) and glaucoma in 11(12.5%). Post-operatively viral keratitis in the graft occurred significantly more inViral Scar Group (38.6%, n=15) than in Microbial Scar Group (5.5%, n=3). But there was no significant difference in graft clarity, rejection, vision and secondary glaucoma between the two Groups. Conclusion: Outcome of keratoplasty for post-infectious scars was found fairly satisfactory. Although occurrence of viral keratitis was higher in case of keratoplasty done for Viral Scars, the final result was similar to that of microbial scar.
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Wang, Michael Y., and Barth A. Green. "Laminoplasty for the treatment of failed anterior cervical spine surgery." Neurosurgical Focus 15, no. 3 (2003): 1–4. http://dx.doi.org/10.3171/foc.2003.15.3.7.
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Object Cervical stenotic myelopathy can be treated via anterior or posterior approaches. In anterior cervical decompression and fusion (ACDF), because the risks and likelihood of pseudarthrosis increase with the number of treated segments, attempts are typically made to limit the number of treated levels. Thus, postoperative recurrence of myelopathy following ACDF may occur because stenotic levels were not treated or because adjacent segments have degenerated. Revision decompressive surgery via an anterior approach is one solution; however, if the stenosis involves multiple levels a posterior decompressive laminoplasty can be performed as an alternative. Methods Twenty-four cases treated over an 8-year period were identified and data were retrospectively reviewed. In 15 cases posterior decompressive surgery was necessary because of progressive spinal degeneration and stenosis (five cases following initial treatment for radiculopathy, seven after initial treatment for spondylotic myelopathy, and three due to spreading of an ossified posterior longitudinal ligament). In nine cases revision surgery was undertaken because the initial decompression was inadequate. The mean follow-up period after the second surgery was 16 months. Improvements in myelopathy were seen in 83% of patients (mean improvement of 1.25 points on the Nurick Scale). Preoperative severe gait disorders were associated with poor recovery. Complications included two cases of transient C-5 nerve root palsy and two cases of new persistent axial neck pain. Conclusions Laminoplasty is a straightforward and effective treatment for failed ACDF due to inadequate decompression or progressive degeneration of the spinal column, avoiding reentry through scar tissue. In terms of myeolpathic pain, the recovery rate is comparable with that related to revision ACDF.
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Karatag, Tuna, Ibrahim Buldu, Mehmet Kaynar, Hakan Taskapu, Erdem Tekinarslan, and Mustafa Okan Istanbulluoglu. "Treatment of Symptomatic Lower Pole Stones of a Kidney with Partial Nephrectomy Using Micropercutaneous Nephrolithotomy Technique." Case Reports in Urology 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/456714.
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We present the treatment of lower pole stones of a 62-year-old male patient with a history of open partial nephrectomy due to renal angiomyolipoma and renal stones. He was successfully treated with micropercutaneous nephrolithotomy technique under spinal anesthesia in spite of fibrotic and scar tissue due to previous open surgery. The patient was stone-free and was discharged after a 24-hour hospitalization period. There is not any published report of micropercutaneous nephrolithotomy in a partial nephrectomized kidney before. In this report, we suggest that microperc technique may be considered for challenging conditions in case of failed retrograde intrarenal surgery.
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Hung, CF. "Origin of Myofibroblasts in Lung Fibrosis." Current Tissue Microenvironment Reports 1, no. 4 (2020): 155–62. http://dx.doi.org/10.1007/s43152-020-00022-9.
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Abstract Purpose of Review In this brief review, we will highlight important observational and experimental data in the literature that address the origin of scar-forming cells in lung fibrosis. Recent Findings Several cellular sources of activated scar-forming cells (myofibroblasts) have been postulated including alveolar epithelial cells; circulating fibrocytes; and lung stromal cell subpopulations including resident fibroblasts, pericytes, and resident mesenchymal stem cells. Recent advances in lineage-tracing models, however, fail to provide experimental evidence for epithelial and fibrocyte origins of lung myofibroblasts. Resident mesenchymal cells of the lung, which include various cell types including resident fibroblasts, pericytes, and resident mesenchymal stem cells, appear to be important sources of myofibroblasts in murine models of lung injury and fibrosis. Summary Lung myofibroblasts likely originate from multiple sources of lung-resident mesenchymal cells. Their relative contributions may vary depending on the type of injury. Although lineage-tracing experiments have failed to show significant contribution from epithelial cells or fibrocytes, they may play important functional roles in myofibroblast activation through paracrine signaling.
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Ge, Isabell, Carmen Geißler, Alexandra Geffroy, Ingolf Juhasz-Böss, Philipp Wiehle, and Jasmin Asberger. "Treatment of Cesarean Scar and Cervical Pregnancies Using the Ovum Aspiration Set for Intrachorial Methotrexate Injection as a Conservative, Fertility-Preserving Procedure." Medicina 59, no. 4 (2023): 761. http://dx.doi.org/10.3390/medicina59040761.
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Background and Objectives: Cesarean scar and cervical pregnancies are rare forms of ectopic pregnancies, occurring in 1 in 2000 and 1 in 9000 pregnancies, respectively. Both entities are medically challenging due to their high morbidity and mortality potential. Materials and Methods: In this retrospective study, we analyzed all cesarean scar and cervical pregnancies from 2010 to 2019 in the Department of Gynecology and Obstetrics of the University Hospital Freiburg, treated with both intrachorial (using the ovum aspiration set) and systemic methotrexate application. Results: We identified seven patients with a cesarean scar and four patients with cervical pregnancies. At diagnosis, the median gestational age was 7 + 1 (range: 5 + 5–9 + 5) weeks and the mean value of ß-hCG was 43,536 (range: 5132–87842) mlU/mL. On average, one dose of intrachorial and two doses of systemic methotrexate were administered per patient. The efficacy rate was 72.7% with three patients (27.3%) needing an additional surgical or interventional procedure. The uterus was preserved in 100% of the patients. Out of the eight patients with follow-up data, five reported subsequent pregnancies (62.5%) that resulted in six live births. None had recurrent cesarean scars or cervical pregnancies. In the subgroup analyses, when comparing cesarean scar pregnancies to cervical pregnancies, patient characteristics, treatment modality, and the outcome did not differ significantly, except for parity (2 versus 0, p = 0.02) and the duration since the last pregnancy (3 vs. 0.75 years, p = 0.048). When comparing cases with successful and failed methotrexate-only treatments, the maternal age was significantly higher in the successful group (34 vs. 27 years, p = 0.02). Localization of the gestation, gestational and maternal age, ß-hCG, and history of preceding pregnancies were non-predictive for the efficacy of the treatment. Conclusions: The combined application of intrachorial and systemic methotrexate for the treatment of cesarean scar and cervical pregnancies has been proven effective, well-tolerated, organ- and fertility-conserving with a low complication rate.
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Thind, Nancy, Pranav Sood, Rajeev Sood, and Geetika Gupta Syal. "Comparison of the efficacy, safety, acceptability and fetomaternal outcomes of combination of mifepristone and foley’s catheter with foley’s catheter alone in induction of labour in term pregnancies with previous lower segment caesarean section." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 10 (2020): 4181. http://dx.doi.org/10.18203/2320-1770.ijrcog20204310.
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Background: Objective of the study was to compare the efficacy, safety, acceptability, fetomaternal outcomes of combination of mifepristone and Foley’s catheter with Foley’s catheter alone in induction of labor in term pregnancies with previous Lower segment caesarean section (LSCS).Methods: This was a prospective study of 36 women induced with mifepristone and foley’s catheter and 36 women induced with foley’s catheter alone at 37 weeks to 41+6 weeks with previous LSCS.Results: Mean bishop score on admission in combined group (2.44) was comparable with that of foley’s alone group (2.91, p=0.888). Mean Bishop score (BS) after foley’s expulsion in group A and group B was 7.46 and 6.33 respectively, which was statistically significant (p<0.001). In group A 69.5% of women delivered vaginally compared to 52.2% in group B which was comparable (p=0.230). Mean induction to delivery interval was significantly short in combination group (15.5±1.3 hours versus 20.8±1.07 hours, p=0.003). 50% women in group A required oxytocin for induction/ augmentation of labour as compared to 77.8% in group B (p=0.02). Failed induction was statistically higher in group B (p<0.05). No difference was found with regards scar dehiscence, scar rupture, Postpartum hemorrhage (PPH), wound infection, puerperal pyrexia, Meconium stained liquor (MSL), fetal distress, mean birth weight, 1 and 5 minutes Appearance, pulse, grimace, activity, and respiration (APGAR) score, neonatal outcome, hospital stay.Conclusions: Priming with mifepristone before insertion of foley’s catheter results in significant change in BS signifying that combination promotes early cervical ripening as compared to foley’s catheter alone. Mifepristone plays significant role in cervical ripening, reduces induction to delivery interval, oxytocin requirement and failed induction.
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Panwar, Pradeep, Hetish M. Reddy, Rajendra Bagree, and Gaurav Jalendra. "Experience with laparoscopic common bile duct exploration in failed endoscopic retrograde cholangiopancreatography cases at a tertiary care hospital." International Surgery Journal 7, no. 10 (2020): 3344. http://dx.doi.org/10.18203/2349-2902.isj20204134.
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Background: Minimally invasive techniques for stone removal in common bile duct (CBD) are endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) or laparoscopic CBD exploration with LC (laparoscopic common bile duct exploration (LCBDE) and LC). Failed, multiple attempted or complications of ERCP leads to other surgical approaches where LCBDE is a preferable option by experts due to its added benefits.Methods: We did LCBDE and LC in 40 cases of failed ERCP. Standard investigation protocol was followed in all cases and CBD were explored laparoscopically and stones were retrieved. Post retrieval choledochoscopy was done and sphincter of oddi was dilated by the dilators.Results: With careful selection of cases, stone calculi were retrieved successfully in 38 cases by laparoscopically and 2 cases by open method after conversion. Postoperative choledochoscopy were found normal. Bile leak seen in 3 cases, which were managed conservatively. Standard regime of postoperative care was taken followed by T-tube removal after cholangiogram on day 10-14. All patients survived the operation.Conclusion: We advocate that LCBDE is the most viable alternative for open surgery in failed ERCP cases for retrieval of CBD stones. This results in early recovery, better cosmetic scar, least complications with early resumption of routine life. Needs cautious patient selection and expertise in laparoscopic surgery.