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Crossed Renal Ectopia and Aorto-Occlusive Disease: A Management Strategy
Eugene Ng,Ian Campbell,Andrew MTL Choong,Nigel Dunglison,Maged Aziz 대한흉부외과학회 2015 Journal of Chest Surgery (J Chest Surg) Vol.48 No.5
We present a rare case of a patient with aortoiliac occlusive disease on the background of type A crossed renal ectopia, for whom open surgical intervention was required. Aortic exposure in patients with concomitant crossed renal ectopia can present technical challenges to the vascular surgeon. The knowledge of variations in the ectopic renal blood supply is of paramount importance when performing surgery to treat this condition and affects the choice of surgical exposure. We present and discuss the operative details of our patient and outline an approach to this subset of patients.
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Eugene Pak-Lin Ng,Andrew Siu-Leung Yip,Keith Hay-Man Wan,Michael Siu Hei Tse,Kam Kwong Wong,Tik-Koon Kwok,Wing Cheung Wong 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.2
Study Design: A retrospective review of patients who underwent 2-level anterior cervical discectomy and fusion (ACDF) with stand-alone polyetheretherketone (PEEK) cages for cervical spondylotic myelopathy (CSM). Purpose: To evaluate the efficacy of stand-alone PEEK cage in 2-level cervical interbody fusion for CSM. Overview of Literature: ACDF is a standard surgical procedure to treat degenerative disc disease. However, the use of additional anterior plating for 2-level ACDF remains controversial. Methods: We reviewed outcomes of patients who underwent 2-level ACDF with stand-alone PEEK cages for CSM over a 7-year period (2007–2015) in a regional hospital. Japanese Orthopaedic Association (JOA) score, fusion rate, subsidence rate, cage migration, and cervical alignment by the C2–7 angle as well as the local segmental angle (LSA) of the cervical spine were assessed. Results: In total, 31 patients (mean age, 59 years; range, 36–87 years) underwent 2-level ACDF with a cage-only construct procedure between 2007 and 2015. The minimum follow-up was 24 months; mean follow-up was 51 months. C3–5 fusion was performed in 45%, C4–6 fusion in 32%, and C5–7 fusion in 23%. Mean JOA score improved from 10.1±2.2 to 13.9±2.1 (p<0.01) at the 24-month follow-up. Fusion was achieved in all patients. Subsidence occurred in 22.5% of the cages but was not associated with differences in JOA scores, age, sex, or levels fused. Lordosis of the C2–7 angle and LSA increased after surgery, which were maintained for up to 1 year but subsequently disappeared after 2 years, yet the difference was not statistically significant. No cage migration was noted; two patients developed adjacent segment disease requiring posterior laminoplasty 3 years after ACDF. Conclusions: The use of a stand-alone PEEK cage in a 2-level cervical interbody fusion achieves satisfactory improvements in both clinical outcomes and fusion.
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Hey Hwee Weng Dennis,Ng Nathaniel Li-Wen,Loh Khin Yee Sammy,Tan Yong Hong,Tan Kimberly-Anne,Moorthy Vikaesh,Lau Eugene Tze Chun,Liu Gabriel Ka-Po,Wong Hee-Kit 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.1
Study Design: Prospective radiographic comparative study.Purpose: To compare and understand the load-bearing properties of each functional spinal unit (FSU) using three commonly assumed, physiological, spinal postures, namely, the flexed (slump sitting), erect (standing) and extended (backward bending) postures. Overview of Literature: Sagittal spinal alignment is posture-dependent and influences the load-bearing properties of the spine. The routine placement of intervertebral cages “as anterior as possible” to correct deformity may compromise the load-bearing capabilities of the spine, leading to complications.Methods: We recruited young patients with nonspecific low back pain for <3 months, who were otherwise healthy. Each patient had EOS images taken in the flexed, erect and extended positions, in random order, as well as magnetic resonance imaging to assess for disk degeneration. Angular and disk height measurements were performed and compared in all three postures using paired t-tests. Changes in disk height relative to the erect posture were caclulated to determine the alignment-specific load-bearing area of each FSU.Results: Eighty-three patients (415 lumbar intervertebral disks) were studied. Significant alignment changes were found between all three postures at L1/2, and only between erect and flexion at the other FSUs. Disk height measurements showed that the neutral axis of the spine, marked by zones where disk heights did not change, varied between postures and was level specific. The load-bearing areas were also found to be more anterior in flexion and more posterior in extension, with the erect spine resembling the extended spine to a greater extent.Conclusions: Load-bearing areas of the lumbar spine are sagittal alignment-specific and level-specific. This may imply that, depending on the surgical realignment strategy, attention should be paid not just to placing an intervertebral cage “as anterior as possible” for generating lordosis, but also on optimizing load-bearing in the lumbar spine.
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Kit-Fai Lee,Kandy Kam Cheung Wong,Eugene Yee Juen Lo,Janet Wui Cheung Kung,Hon-Ting Lok,Charing Ching Ning Chong,John Wong,Paul Bo San Lai,Kelvin Kwok Chai Ng 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.1
Backgrounds/Aims: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) remains a dreadful complication. Duct-to-mucosa pancreaticojejunostomy (DTMPJ) is a commonly performed anastomosis after PD. This study aims to evaluate whether there is a size limit of pancreatic duct below which POPF rate increases significantly after DTMPJ. Methods: A retrospective study was performed from a database with prospectively collected data on consecutive patients undergoing DTMPJ. Results: Between the years 2003 and 2019, a total of 288 patients with DTMPJ were recruited. POPF occurred in 56.3% of the patients, of which 43.8% were biochemical leak, 8.7% were grade B, and 1.4% were grade C. Overall operative morbidity was 51.4%, of which 19.1% were major complications. Five patients (1.7%) died within 90 days of operation. Patients with grade B/C POPF had significantly soft pancreas (p < 0.001), smaller duct size (p = 0.031), and a diagnosis of carcinoma of the pancreas (p = 0.027). When a clinically significant POPF rate was analysed based on the pancreatic duct diameter, pancreatic duct size ≤ 1 mm had the highest POPF rate (35.7%). There was a significant difference in POPF rate between adjacent ductal diameter ≤ 1 mm and > 1 mm to 2 mm (35.7% vs 13.3%; p = 0.040). Multivariable analysis showed that for the soft pancreas, pancreatic duct diameter ≤ 1 mm was the only significant predictive factor for POPF (p = 0.027). Conclusions: DTMPJ can be safely performed for pancreatic duct > 1 mm without significantly increased POPF risk.
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