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Chen M.R.,Stanford Hospital and Clinics
The Journal of the American Academy of Orthopaedic Surgeons | Year: 2011

Intra-articular inflammation or fibrosis may lead to decreased soft-tissue and capsular compliance, which may result in pain or loss of motion within the knee. Etiology of intra-articular fibrosis may include isolated anterior interval scarring and posterior capsular contracture, as well as fibrosis that involves the suprapatellar pouch or arthrofibrosis that involves the entire synovial space. Initial nonsurgical management, including compression, elevation, and physical therapy, can decrease knee pain and inflammation and maintain range of motion. Surgical management is indicated in the patient who fails conservative treatment. Surgical options include arthroscopic releases of the anterior interval, posterior capsule, and peripatellar and suprapatellar regions. Recent advances in arthroscopic technique have led to improved outcomes in patients with intra-articular fibrosis of the knee. Source

Shih H.B.,Stanford Hospital and Clinics
Annals of Plastic Surgery | Year: 2016

INTRODUCTION: Lymphaticovenous anastomosis (LVA) is a surgical treatment option for patients with early stage lymphedema. To date, no ideal imaging modality exists for tracking patency of the LVA postoperatively. We hypothesize that laser angiography utilizing indocyanine green (ICG) via the SPY system (Lifecell Corp.) would be a useful methodology for assessing the patency of the LVA and lymphatic recovery postoperatively. METHODS: A prospective trial was performed on patients with stage II lymphedema who underwent LVA from 2013 to 2014 by a single surgeon. All candidates underwent preoperative and postoperative lymphatic mapping using ICG-SPY angiography. Postoperative analyses were performed at 1 month and at 9 months after surgery and assessed for patency at the site of the LVAs and for changes in lymphatic pattern. RESULTS: Five patients underwent LVA, 3 for upper extremity and 2 for lower extremity stage II lymphedema. The number of LVAs per extremity was 1 to 3 (total, 11). One month postoperative ICG-SPY angiography demonstrated flow through 9 of 11 anastomoses. Evaluation at 9 months postoperative showed improvement in lymphatic drainage. CONCLUSIONS: Indocyanine green-SPY angiography may be used to objectively evaluate the surgical outcome of LVA. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Source

Venkatesan A.,Stanford Hospital and Clinics
Dermatologic Clinics | Year: 2010

Approximately one of every 10 women has a pigmented vulvar lesion. Given the risk of melanomas and pigmented vulvar intraepithelial neoplasia (squamous cell carcinoma in situ), proper evaluation of vulvar pigmented lesions is critical. Most vulvar lesions are benign; however, vulvar lesions grossly, dermoscopically, and histologically can appear atypical compared with pigmented lesions on the rest of the body. Thus, it is imperative to use not only a keen eye but also a low threshold for biopsy. © 2010 Elsevier Inc. Source

Shu B.,Stanford Hospital and Clinics | Safran M.R.,Stanford University
Clinics in Sports Medicine | Year: 2011

Hip instability is uncommon because of the substantial conformity of the osseous femoral head and acetabulum. It can be defined as extraphysiologic hip motion that causes pain with or without the symptom of hip joint unsteadiness. The cause can be traumatic or atraumatic, and is related to both bony and soft tissue abnormality. Gross instability caused by trauma or iatrogenic injury has been shown to improve with surgical correction of the underlying deficiency. Subtle microinstability, particularly from microtraumatic or atraumatic causes, is an evolving concept with early surgical treatment results that are promising. © 2011 Elsevier Inc. Source

Schaffer J.M.,Stanford Hospital and Clinics | Singh S.K.,Stanford Hospital and Clinics | Joyce D.L.,Stanford Hospital and Clinics | Reitz B.A.,Stanford Hospital and Clinics | And 3 more authors.
Circulation | Year: 2013

Background-Lung transplantation and heart-lung transplantation represent surgical options for treatment of medically refractory idiopathic pulmonary arterial hypertension. The effect of the lung allocation score on wait-list and transplantation outcomes in patients with idiopathic pulmonary arterial hypertension is poorly described. Methods and Results-Adults diagnosed with idiopathic pulmonary arterial hypertension and listed for transplantation in the 80 months before and after the lung allocation score algorithm was implemented (n=1430) were identified in the United Network for Organ Sharing thoracic registry. Patients were stratified by organ listed and pre-and post-lung allocation score era. The cumulative incidences of transplantation and mortality for wait-listed patients in both eras were appraised with competing outcomes analysis. Posttransplantation survival was assessed with the Kaplan-Meier method. These analyses were repeated in propensity-matched subgroups. Cox proportional hazards analysis evaluated the effect of prelisting and pretransplantation characteristics on mortality. We found that patients in the post-lung allocation score era had significantly worse comorbidities; nevertheless, both lung transplantation and heart-lung transplantation candidates in this era enjoyed lower wait-list mortality and a higher incidence of transplantation in unmatched and propensity-matched analyses. On multivariable analysis, heart-lung transplantation and double-lung transplantation were associated with improved survival from the time of wait-listing, as was being listed at a medium-to high-volume institution. Donor/recipient sex matching predicted posttransplantation survival. Conclusions-The incidence of transplantation has increased while wait-list mortality has decreased in patients with idiopathic pulmonary arterial hypertension wait-listed for transplantation in the post-lung allocation score era. Both heart-lung transplantation and double-lung transplantation are predictive of survival in transplantation candidates with idiopathic pulmonary arterial hypertension, as is being listed at a medium-to high-volume institution. Donor/recipient sex matching is associated with better posttransplantation survival. © 2013 American Heart Association, Inc. Source

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