Recent Publications by CFE Educators

OBJECTIVES

Limited articles are published on reoperative urethroplasty outcomes. We sought to perform a systematic review of re-operative urethroplasty articles over the past fifteen years.

METHODS

A systematic review was performed on PubMed using the search terms "Urethra" AND "Surgical Procedures, Operative" OR "Urethroplasty".

RESULTS

Five articles out of 3,541 articles identified between 1998 and 2012 specifically addressed re-operative urethroplasty patients. A total of 212 patients were included in these five studies. Re-operative urethroplasty success rates ranged from 35% to 84%. Success rates were higher in the two studies with over 40 patients and ranged from 78-84%.

CONCLUSION

Limited studies address re-operative urethroplasty outcomes. Success rates for re-operation are lower than those for initial urethroplasty procedures. Overall, studies with a higher number of patients had an increased success rate.

BACKGROUND

The goal of this study was to review a single institution's experience using intraoperative ultrasound-guided (ioUSG) methylene blue dye injection for the localization and removal of enlarged parathyroid glands in patients with primary hyperparathyroidism and a history of previous neck surgery.

METHODS

We performed a retrospective review of nine consecutive patients who underwent reoperative parathyroidectomy using ioUSG methylene blue dye injection.

RESULTS

All patients had successful resolution of their hyperparathyroidism, with at least a 50 % decrease in intraoperative parathyroid hormone level after resection. One patient had transient recurrent laryngeal nerve paresis. There were no permanent recurrent laryngeal nerve injuries or cases of permanent hypoparathyroidism.

CONCLUSIONS

Blue dye injection is a safe and effective method of localizing diseased parathyroid glands in the reoperative neck.

The diagnosis of multiple sclerosis (MS) is based on demonstrating evidence of inflammatory-demyelinating injury within the central nervous system that is disseminated in both time and space. Diagnosis is made through a combination of the clinical history, neurologic examination, magnetic resonance imaging and the exclusion of other diagnostic possibilities. Other so-called "paraclinical" tests, including the examination of the cerebrospinal fluid, the recording of evoked potentials, urodynamic studies of bladder function, and ocular coherence tomography, may be helpful in establishing the diagnosis for individual patients, but are often unnecessary. Differential diagnosis in MS must be guided by clinical presentation and neurologic localization. While the list of conditions that can mimic MS clinically or radiologically is long, in clinical practice there are few conditions that truly mimic MS on both fronts. A positive test for a putative MS "mimic" does not unto itself exclude the diagnosis of MS. Typical symptoms of MS include discrete episodes ("attacks" or "relapses") of numbness, tingling, weakness, vision loss, gait impairment, incoordination, imbalance, and bladder dysfunction. In between attacks, patients tend to be stable, but may experience fatigue and heat sensitivity. Some MS patients go on to experience, or only experience, an insidious worsening of neurologic function and accumulation of disability ("progression") that is not associated with discrete relapse activity. Progression accounts for most of the long-term disability in MS. Diagnostic criteria for MS have evolved over the past several decades, with each revision impacting the apparent prevalence and prognosis of the disorder - the result has been to encourage earlier diagnosis without compromising accuracy.