1.Segmental Hemihyperplasia-Related Macrodactyly with Congenital Renal Agenesis: A Hand Surgeon's Point of View.
Joao Nunes DA COSTA ; Julio MATIAS
Archives of Plastic Surgery 2015;42(5):655-658
No abstract available.
Hand*
2.Transcranial Doppler emboli monitoring for stroke prevention after flow diverting stents
Matias COSTA ; Paul SCHMITT ; Jaleel N ; Matias BALDONCINI ; Juan VIVANCO-SUAREZ ; Bipin CHAURASIA ; Colleen DOUVILLE ; Loh YINCE ; Akshal PATEL ; Stephen MONTEITH
Journal of Cerebrovascular and Endovascular Neurosurgery 2024;26(1):23-29
Objective:
Flow diverting stents (FDS) are increasingly used for the treatment of intracranial aneurysms. While FDS can provide flow diversion of parent vessels, their high metal surface coverage can cause thromboembolism. Transcranial Doppler (TCD) emboli monitoring can be used to identify subclinical embolic phenomena after neurovascular procedures. Limited data exists regarding the use of TCDs for emboli monitoring in the periprocedural period after FDS placement. We evaluated the rate of positive TCDs microembolic signals and stroke after FDS deployment at our institution.
Methods:
We retrospectively evaluated 105 patients who underwent FDS treatment between 2012 and 2016 using the Pipeline stent (Medtronic, Minneapolis, MN, USA). Patients were pretreated with aspirin and clopidogrel. All patients were therapeutic on clopidogrel pre-operatively. TCD emboli monitoring was performed immediately after the procedure. Microembolic signals (mES) were classified as “positive” (<15 mES/hour) and “strongly positive” (>15 mES/hour). Clinical stroke rates were determined at 2-week and 6-month post-operatively.
Results:
A total of 132 intracranial aneurysms were treated in 105 patients. TCD emboli monitoring was “positive” in 11.4% (n=12) post-operatively and “strongly positive” in 4.8% (n=5). These positive cases were treated with heparin drips or modification of the antiplatelet regimen, and TCDs were repeated. Following medical management modifications, normalization of mES was achieved in 92% of cases. The overall stroke rates at 2-week and 6-months were 3.8% and 4.8%, respectively.
Conclusions
TCD emboli monitoring may help early in the identification of thromboembolic events after flow diversion stenting. This allows for modification of medical therapy and, potentially, preventionf of escalation into post-operative strokes.
3.XCM Biologic Tissue Matrix xenograft and autologous micromucosa graft for vaginal reconstruction in Mayer-Rokitansky-Küster-Hauser syndrome
Tatiana Gigante GOMES ; Mariana AGOSTINHO ; Mariana Conceição CARDOSO ; João Nunes da COSTA ; Júlio MATIAS
Archives of Plastic Surgery 2021;48(2):185-188
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome can be treated through numerous surgical and nonsurgical methods. We present a surgical technique in which a neovagina was reconstructed and shaped by a vaginal expander with acellular porcine dermal matrix (XCM Biologic Tissue Matrix) and mucosal interposition using microfragments harvested from the hymen. In our case, we found this procedure to be safe and effective, resulting in satisfactory sexual function and good cosmetic results, without donor site morbidity. To our best knowledge, this tissue-engineered biomaterial has never been used for vaginal reconstruction before.