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Solaiman RH, Shih Y, Bakker C, Arendt EA, Tompkins MA. Tibial derotational osteotomy for idiopathic tibial torsion: A systematic review of surgical indications based on clinical presentation and measurement technique. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38713870 DOI: 10.1002/ksa.12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE The aim of this systematic review was to identify the surgical indications of tibial derotational osteotomy (TDO) in patients with idiopathic external tibial torsion (ETT) and identify common measurement thresholds for surgical correction. METHODS A systematic search of MEDLINE and Embase via Ovid, Cochrane Library via Wiley, Web of Science, Scopus, SPORTDiscus via EBSCOhost, ClinicalTrials.gov, WHO ICTRP and Global Index Medicus databases was performed with search terms reflecting the concepts of idiopathic tibial torsion, TDOs, and surgical indications. Studies reporting surgical indications and measurement methods of idiopathic tibial torsion in patients who underwent TDO were included. Two authors independently screened articles and extracted data that was characterized with descriptive statistics. RESULTS Seventeen studies were identified for inclusion, with 460 tibias and 351 patients. Nearly all patients who underwent surgery had either anterior knee pain or patellar instability, even if other indications were present. Of all included patients, the most common surgical indications for TDO were anterior knee pain (88%), patellar instability (59%), gait dysfunction (41%) and cosmetic deformity (12%). Twelve studies (71%) cited multiple of these indications as reasons for surgery. On physical exam, tibial torsion was measured most commonly by thigh-foot angle (59%) (TFA) and transmalleolar axis (24%) (TMA). In terms of TFA, the most frequently reported cut-off for ETT was >30° (35%). Computerized tomography (CT) was used by nine studies (53%). The most common CT axes used to measure ETT were the TMA with respect to the posterior tibia condylar axis or the bicondylar tibia axis. CONCLUSION Anterior knee pain and/or patellar instability are common indications for TDO in patients with idiopathic tibial torsion. Standardized TFA thresholds (>30°) and CT measurement methods (TMA and posterior tibia condylar or bicondylar tibial axis) may help further establish objective surgical indications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Rafat H Solaiman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yushane Shih
- Department of Orthopedic Surgery, Texas Children's Hospital, Woodlands, Texas, USA
| | - Caitlin Bakker
- Archer Library, University of Regina, Regina, Saskatchewan, Canada
| | - Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc A Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Liu Y, Bao M, Jiang Y, Li F, Xing W, Yang Z, Liu Q. Optimization of therapeutic strategies for selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in patients with rectal cancer with clinical suspected lateral lymph node metastasis. Front Oncol 2023; 13:1271463. [PMID: 37886180 PMCID: PMC10598648 DOI: 10.3389/fonc.2023.1271463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/13/2023] [Indexed: 10/28/2023] Open
Abstract
Background Selective lateral lymph node (LLN) dissection with total mesorectal excision after neoadjuvant chemoradiotherapy (nCRT) is pointed out to reduce lateral compartment recurrence and to improve survival in patients with rectal cancer with LLN metastases. This study aimed to explore the safety, surgical indications, and survival outcomes of LLN dissection after nCRT. Methods This multicenter retrospective study included patients with rectal cancer with clinical evidence of LLN metastases (n = 466) treated across three hospitals in China. Patients who underwent total mesorectal excision and LLN dissection were grouped into nCRT (n = 155) and non-nCRT (n = 291), respectively. Propensity score matching was used to minimize selection bias. Results After matching, nCRT did not significantly increase the surgery duration, intraoperative blood loss or postoperative complications (P > 0.05). In a multivariate logistic regression analysis, poor/mucinous/signet adenocarcinoma (P = 0.042) and post-nCRT LLN short diameter ≥7 mm (P < 0.001) were independent risk factors for pathological LLN metastasis after nCRT. Overall survival (P < 0.001) and disease-free survival (P < 0.001) were significantly worse in patients with LLN metastasis, which was, however, not an independent risk factor for survival after eliminating confounders. Multivariate prognostic analysis of 40-patient subset with pathological LLN metastasis showed that distant metastasis, metastasis beyond the obturator or internal iliac region, and ≥2 LLN metastasis were independent predictors of poor overall survival. Conclusions Selective LLN dissection after nCRT is safe and feasible with acceptable perioperative outcomes. Patients with a post-nCRT LLN short diameter ≥7 mm or poor/mucinous/signet adenocarcinoma should receive supplementary LLN dissection after nCRT. However, patients with distant metastasis, metastasis beyond the obturator or internal iliac region, and involvement of ≥2 LLN may not benefit from LLN dissection, and LLN dissection should be carefully considered in such patients.
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Affiliation(s)
- Yuan Liu
- Department of Surgery, Hebei Province Hospital of Chinese Medicine/Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Mandoula Bao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yujuan Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Wei Xing
- Department of Surgery, Hebei Province Hospital of Chinese Medicine/Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Zhufeng Yang
- Department of Surgery, Hebei Province Hospital of Chinese Medicine/Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Venugopal Menon K, Basu S, Oka G, Gohil K. Delphi-Based Survey for Surgical Indications in Biopsy Proven Active Adult Spinal Tuberculosis. Global Spine J 2023:21925682231204157. [PMID: 37776140 DOI: 10.1177/21925682231204157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
STUDY DESIGN Delphi survey. OBJECTIVES To obtain an expert consensus on various dilemmas in the surgical treatment of adult spinal tuberculosis (TB) patients. METHODS Stage I included a literature review, stage II the identification of 40 Key Opinion leaders (KOLs) and a set of 46 questions, stage III included analysis of 3 rounds of the Delphi survey, and stage IV had final analysis and recommendations. For each question, the level of agreement needed to reach a consensus was set at greater than or equal to 70.0%. RESULTS The first and second Delphi survey rounds received 62 and 58 responses, respectively, with 16 questions having more than 70% and two questions having 100% agreement in the first stage. The second stage saw a 70% agreement on six questions. Thus, a consensus was obtained on 22 questions. The recommendations that emerged were as follows: neurodeficit with corresponding radiology and neurological deficit appearing/deteriorating while on anti-tubercular chemotherapy(ATT) are absolute indications for surgery, duration of ATT before neurological deterioration need not be considered, epidural abscess does not need decompression unless concordant clinical neurological findings are present, pain not responding to medical management is not a surgical indication, active pulmonary TB, drug-resistant TB, and tubercular sacroiliitis are not considered as surgical indications, and hemoglobin and other health markers have little contribution to surgical indications. CONCLUSION In order to resolve several conundrums in the surgical treatment of adult spinal TB, this Delphi survey is the first to achieve a national consensus from spine experts. The final recommendations cover the serological, radiographic, and clinical aspects of spinal TB.
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Affiliation(s)
- K Venugopal Menon
- Department of Orthopedics, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Saumyajit Basu
- Head of Department of Spine Surgery, Kothari Medical Centre, Kolkata, India
| | - Gauri Oka
- Research Consultant, Central Research and Publication Unit, Bharati Vidyapeeth Medical College and Hospital, Pune, India
| | - Kushal Gohil
- Department of Orthopedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
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Clark A, Forner D, Noel CW, Corsten G, Hong P. Need for Tympanostomy Tubes in Children With Recurrent Acute Otitis Media Without Middle Ear Effusion. Otolaryngol Head Neck Surg 2023; 169:694-700. [PMID: 36939487 DOI: 10.1002/ohn.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Children with recurrent acute otitis media (RAOM) presenting without middle ear effusion (MEE) do not meet indications for surgical intervention as outlined by Clinical Practice Guidelines (CPGs). The objective of this study was to determine which patients presenting with RAOM without MEE ultimately received tympanostomy tubes. STUDY DESIGN Case series. SETTING Single academic pediatric otolaryngology clinic. METHODS Children (0-12 years) presenting with RAOM and no MEE were identified from October 2017 to December 2019. As per CPGs, no surgery was offered initially. Patients were given a semiurgent return appointment should they experience another suspected otitis media episode. If MEE was observed, tympanostomy tube insertion was offered. Patients were followed for 1-year following enrollment. RESULTS One-hundred and twenty-four patients were included. The median age was 3.15 years old (interquartile range: 4.10). Seventy-five (60%) patients did not require additional follow-up and thus did not require tympanostomy tubes. Forty-nine (40%) patients were seen again; of these, 11 patients received tympanostomy tubes. Therefore, of patients presenting with no MEE, 91% did not require tympanostomy tubes. Patients who had surgery were younger on initial assessment than those who did not (mean difference 2.68 years, 95% confidence interval: 2.14-3.23). CONCLUSION This study demonstrates the practical effect of adhering to CPGs for RAOM and suggests that many children may not require tympanostomy tube placement within the 1st year after the consultation if they did not initially present with MEE.
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Affiliation(s)
- Alexander Clark
- Division Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Forner
- Division Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gerard Corsten
- Division Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Paul Hong
- Division Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
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Chen X, Deng YD, Qiu XS, Chen YX, Zhang ZT. Analysis of the curative effect and prognostic factors in patients with scapular fracture with surgical indications after conservative treatment: a case series and clinical outcomes. Quant Imaging Med Surg 2023; 13:5130-5140. [PMID: 37581085 PMCID: PMC10423348 DOI: 10.21037/qims-23-278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/05/2023] [Indexed: 08/16/2023]
Abstract
Background The choice of treatment for scapular fractures is a topic worth discussing. The type of scapular fracture is often complex, and more and more scholars prefer surgical treatment to obtain better shoulder joint function. In addition, because of the rich blood supply and muscles of the scapula, some scholars believe that simple suspension can also achieve satisfactory clinical effects. The aim of this study was to investigate the curative effect and prognostic factors of patients with scapular fracture with indications for surgery after receiving conservative treatment. Methods Patients with scapular fracture who did not receive surgical treatment from July 2016 to May 2021 were recruited from the orthopedic trauma database of Nanjing Gulou Hospital, and the data from patients with indications for surgery were screened out for a retrospective analysis. The data were obtained from the database of orthopaedic trauma patients in Nanjing Drum Tower Hospital. The relevant data were recorded during telephone and video follow-up visits. Linear regression was used to analyze the factors associated with disabilities of the arm, shoulder and hand (DASH) score after receiving conservative treatment. Results A total of 21 patients were included in the final statistical analysis. All patients were followed up for 31.0±20.3 (range, 6-63) months, aged 52.9±12.7 (range, 27-71) years. All fractures had clinical healing with a 100% recovery satisfaction rate. Outcome measures of efficacy [both DASH scores and visual analogue scale (VAS) scores], were correlated with whether the fracture involved the superior border of the scapular, were not associated with the following variables: age (P=0.18), Injury Severity Score (ISS) score (P=0.10), the glenopolar angle (GPA) value (P=0.76), superior shoulder suspensory complex (SSSC) injury (P=0.82), and glenoid fracture (P=0.84). The range of motion of the affected shoulder was significantly reduced compared to the healthy shoulder (P<0.01), but the range of forward flexion and elevation was not significantly different from that of the healthy shoulder (P>0.05). Patients with fractures not involving the superior border of the scapula had a much lower range of motion in the affected shoulder than in the healthy shoulder during abduction (P<0.05). Conclusions The range of surgical indications for scapular fractures with scapular fractures involving the lower margin of the scapular can be appropriately narrowed. Some patients with scapular fracture who have surgical indications can regain satisfactory shoulder function after receiving conservative treatment.
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Affiliation(s)
- Xi Chen
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Shoulder and Elbow Surgery, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Zhengzhou, China
| | - Ya-Dian Deng
- Department of Emergency, The First Affiliated Hospital, Henan Traditional Chinese Medicine University, Zhengzhou, China
| | - Xu-Sheng Qiu
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yi-Xin Chen
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zi-Tao Zhang
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Abstract
Given the low incidence of pulmonary artery aneurysms (PAAs), proven surgical indications do not yet exist. We present a patient with a 6.3 cm PAA who underwent an open sternotomy, pulmonary artery aneurysmectomy, and repair with an aortic homograft. We discuss surgical indications, including pain, growth in diameter, and diameter of 5.5 cm and larger. The current recommended surgical indication for the size of PAAs is based on recommendations for aortic aneurysms and observation in a small number of operable patients, highlighting the need for more discussion and reporting of this rare presentation.
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Affiliation(s)
- Joel Badders
- School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Patrick Roughneen
- Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, USA
| | - Navyatha Mohan
- Surgery, University of Texas Medical Branch, Galveston, USA
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Barrios P, Avella Patino D. Surgical indications for mediastinal cysts-a narrative review. Mediastinum 2022; 6:31. [PMID: 36582980 PMCID: PMC9792824 DOI: 10.21037/med-22-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective Whether and when surgical intervention is indicated for mediastinal cysts is a matter of some debate. While most mediastinal cysts are found incidentally, the anatomic location, clinical presentation, and symptoms, as well as the potential for malignancy, are important considerations that inform decisions related to whether to intervene surgically. The objective of this review is to summarize the current literature regarding the criteria for surgical excision of mediastinal cysts and provide a framework for the clinician and surgeon to arrive at a decision regarding the appropriateness of surgical intervention of mediastinal cysts. Methods A review of the published literature in the last 45 years (1977-2022) was conducted through PubMed, MeSh and Google Scholar. We included retrospective reviews, meta-analyses, and case studies published in the English language. A single author identified eligible studies, and those identified were reviewed by the team until consensus was met. Pediatric literature was excluded from this review. Key Content and Findings The current literature predominantly contains case studies, small retrospective studies, and meta-analyses describing mediastinal cysts. In the anterior mediastinum, multiloculated thymic cysts should be resected to rule out thymic malignancy. Intralesional fat, smooth borders, and a more midline location are features suggestive of a benign process, while asymmetric cystic wall thickening has been associated with malignancy. Both esophageal and bronchogenic cysts should be excised, taking into account the risk of complications (up to a 45% risk) of infection, rupture, or compression, as well as the rare risk of associated malignancy. Simple thymic and small pericardial cysts can be observed and followed with serial radiographic tools and should be resected if they increase in size, compress surrounding structures, or lead the patient to develop symptoms. Conclusions Since mediastinal cysts are rare and often asymptomatic, there are no formal guidelines outlining when surgical intervention should be undertaken. Based on our review of the literature, surgical intervention should be pursued if the patient's symptoms correlate with radiographic findings of a mediastinal cyst, there is compression of the surrounding structures, and concern of malignancy is present.
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Affiliation(s)
- Paola Barrios
- Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Diego Avella Patino
- Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA;,Division of Thoracic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
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Li Y, Jin L, Wu M, Huang Y. Evaluation value of subjective visual quality examination on surgical indications of the early cataracts based on objective scatter index values. Front Med (Lausanne) 2022; 9:1075693. [PMID: 36582278 PMCID: PMC9792837 DOI: 10.3389/fmed.2022.1075693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Aim To evaluate the subjective visual functions of early cataracts patients and assess their surgical indications. Methods Eyes were separated into a control group (Group A without cataract) and two early cataracts groups (Group B with 2.0 ≤ OSI < 3.0 and Group C with 3.0 ≤ OSI < 4.0). The objective scatter index (OSI), modulation transfer function cut-off frequency (MTF cut-off), and Strehl ratio (SR) values were applied to measure objective visual functions. The contrast sensitivity (CS) and scores of the questionnaires (QOL and VF-14) characterized subjective visual functions. Above visual functions were compared among three groups. Postoperative visual functions in Group B and C were analyzed to assess the outcome of surgery. Results Ninety two subjects (126 eyes) were included in the study. All objective visual function in Group B were significantly better than Group C (all P < 0.01), but worse than Group A (all P < 0.01). Except for 1.5 c/d CS, subjective visual function in Group A were significantly better than Group B and C (all P < 0.05), but there was no significant differences between Group B and C. As for eyes that underwent surgery in Group B and C, all visual functions significantly improved after surgery (P < 0.05), except for 1.5 c/d CS in Group C. There were no significant differences among the three groups after surgery. Conclusion The subjective visual function can be impaired in early cataracts patients with OSI < 3.0, whose objective visual functions were statistically better than patients with OSI ≥ 3.0. These patients can benefit equally from surgery as patients with OSI ≥ 3.0. Subjective visual functions can be used as surgical indications for these patients.
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Shore BJ, McCarthy J, Shrader MW, Graham HK, Veerkamp M, Rutz E, Chambers H, Davids JR, Narayanan U, Novacheck TF, Pierz K, Dreher T, Rhodes J, Shilt J, Theologis T, Van Campenhout A, Kay RM. Anterior distal femoral hemiepiphysiodesis in children with cerebral palsy: Establishing surgical indications and techniques using the modified Delphi method and literature review. J Child Orthop 2022; 16:65-74. [PMID: 35615394 PMCID: PMC9124914 DOI: 10.1177/18632521221087529] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to develop consensus for the surgical indications of anterior distal femur hemiepiphysiodesis in children with cerebral palsy using expert surgeon opinion through a modified Delphi technique. METHODS The panel used a 5-level Likert-type scale to record agreement or disagreement with 27 statements regarding anterior distal femur hemiepiphysiodesis. Consensus was defined as at least 80% of responses being in the highest or lowest 2 of the Likert-type ratings. General agreement was defined as 60%-79% falling into the highest or lowest 2 ratings. RESULTS For anterior distal femur hemiepiphysiodesis, 27 statements were surveyed: consensus or general agreement among the panelists was achieved for 22 of 27 statements (22/27, 82%) and 5 statements had no agreement (5/27, 18%). There was general consensus that anterior distal femur hemiepiphysiodesis is indicated for ambulatory children with cerebral palsy, with at least 2 years growth remaining, and smaller (<30 degrees) knee flexion contractures and for minimally ambulatory children to aid in standing/transfers. Consensus was achieved regarding the importance of close radiographic follow-up after screw insertion to identify or prevent secondary deformity. There was general agreement that percutaneous screws are preferred over anterior plates due to the pain and irritation associated with plates. Finally, it was agreed that anterior distal femur hemiepiphysiodesis was not indicated in the absence of a knee flexion contracture. CONCLUSION Anterior distal femur hemiepiphysiodesis can be used to treat fixed knee flexion contractures in the setting of crouch gait, but other associated lever arm dysfunctions must be addressed by single-event multilevel surgery. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Benjamin J Shore
- Boston Children’s Hospital, Boston, MA, USA,Benjamin J. Shore, Boston Children’s Hospital, Boston, MA 02115, USA.
| | - James McCarthy
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - M Wade Shrader
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - H Kerr Graham
- The Royal Children’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Matthew Veerkamp
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Erich Rutz
- The Royal Children’s Hospital Melbourne, Melbourne, VIC, Australia
| | | | - Jon R Davids
- Shriners Hospitals for Children—Northern California, Sacramento, CA, USA
| | | | - Tom F Novacheck
- Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA
| | | | | | | | | | | | | | - Robert M Kay
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
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Kay RM, McCarthy J, Narayanan U, Rhodes J, Rutz E, Shilt J, Shore BJ, Veerkamp M, Shrader MW, Theologis T, Van Campenhout A, Pierz K, Chambers H, Davids JR, Dreher T, Novacheck TF, Graham K. Finding consensus for hamstring surgery in ambulatory children with cerebral palsy using the Delphi method. J Child Orthop 2022; 16:55-64. [PMID: 35615393 PMCID: PMC9124912 DOI: 10.1177/18632521221080474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 01/15/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE There is marked variation in indications and techniques for hamstring surgery in children with cerebral palsy. There is particular uncertainty regarding the indications for hamstring transfer compared to traditional hamstring lengthening. The purpose of this study was for an international panel of experts to use the Delphi method to establish consensus indications for hamstring surgery in ambulatory children with cerebral palsy. METHODS The panel used a five-level Likert-type scale to record agreement or disagreement with statements regarding hamstring surgery, including surgical indications and techniques, post-operative care, and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert-type ratings. General agreement was defined as 60%-79% falling into the highest or lowest two ratings. There was no agreement if neither of these thresholds was reached. RESULTS The panel reached consensus or general agreement for 38 (84%) of 45 statements regarding hamstring surgery. The panel noted the importance of assessing pelvic tilt during gait when considering hamstring surgery, and also that lateral hamstring lengthening is rarely needed, particularly at the index surgery. They noted that repeat hamstring lengthening often has poor outcomes. The panel was divided regarding hamstring transfer surgery, with only half performing such surgery. CONCLUSION The results of this study can help pediatric orthopedic surgeons optimize decision-making in their choice and practice of hamstring surgery for ambulatory children with cerebral palsy. This has the potential to reduce practice variation and significantly improve outcomes for ambulatory children with cerebral palsy. LEVEL OF EVIDENCE level V.
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Affiliation(s)
- Robert M Kay
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,Robert M Kay, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd., #69, Los Angeles, CA 90027, USA.
| | - James McCarthy
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Erich Rutz
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
| | | | | | - Matthew Veerkamp
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - M Wade Shrader
- Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | | | | | | | - Jon R Davids
- Shriners Hospitals for Children – Northern California, Sacramento, CA, USA
| | | | - Tom F Novacheck
- Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA
| | - Kerr Graham
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
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Anoh NA, Kouadio NL, Konan K, Traoré L, GohoK M, Boussou K, Konank JM, Niava GR, Akouwendo E, Kouadio KG. [Ingestion of unusual foreign bodies in adults about two cases observed at the treichville university hospital center]. Mali Med 2022; 37:78-80. [PMID: 38506212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Most of ingested foreign bodies passthrough the digestive tract spontaneously. The surgical care represents less than 1%. We report two cases of unexpected ingested foreign bodies treated surgically during the year 2019 in order to identify the surgical indications through a literaturereview. There were one woman and one man respectivelyaged 46 and 33. The accidentlyingestedforeign bodies werea denture and a toothbrush. An attempt to endoscopically extract the denture was unsuccessful. Peritonitis appeared as the complication in both cases. A radiography of unprepared abdomen showed the foreign body in the epigastic area, associated with a pneumoperitonitis in one case. Gastrostomy through laparotomy allowed to extract the foreign body without any complication. Surgery should be indicated either in complications or failure of endoscopic means to extractlocked foreign bodies.
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Affiliation(s)
- N A Anoh
- Service de chirurgie digestive et proctologique CHU de Treichville
| | - N L Kouadio
- Service de chirurgie digestive et proctologique CHU de Treichville
| | - Kip Konan
- Service de chirurgie digestive et proctologique CHU de Treichville
| | - L Traoré
- Service de chirurgie digestive et proctologique CHU de Treichville
| | - M GohoK
- Service de chirurgie digestive et proctologique CHU de Treichville
| | - Kjc Boussou
- Service de chirurgie digestive et proctologique CHU de Treichville
| | - J M Konank
- Service de chirurgie digestive et proctologique CHU de Treichville
| | - G R Niava
- Service de chirurgie digestive et proctologique CHU de Treichville
| | - E Akouwendo
- Service de chirurgie digestive et proctologique CHU de Treichville
| | - K G Kouadio
- Service de chirurgie digestive et proctologique CHU de Treichville
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12
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Noris A, Peraio S, Di Rita A, Ricci Z, Spezzani C, Lenge M, Giordano F. Pediatric neurosurgery AC-after COVID-19: What has really changed? A review of the literature. Front Pediatr 2022; 10:928276. [PMID: 36160801 PMCID: PMC9490313 DOI: 10.3389/fped.2022.928276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 outbreak has dramatically changed the organization of Pediatric Neurosurgery all over the world. The departments involved developed similar plans to maintain emergency surgeries without reducing clinical activities. The Association of Pediatric Neurosurgeons wrote different memoranda to detail the surgical procedures not to be postponed with special attention given to high-risk pathology for COVID-19 contamination, like trans-naso-sphenoidal surgery. On this basis, we have conducted a complete literature review focusing on many topics: hospital organization, patients and parents screening, surgical indication criteria, outpatient clinic and teleconsultation, telematic conference and meeting, fellowship and training, and virtual multidisciplinary meeting.
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Affiliation(s)
- Alice Noris
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Simone Peraio
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Andrea Di Rita
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Zaccaria Ricci
- Department of Anesthesiology and Intensive Care, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Chiara Spezzani
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Matteo Lenge
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Flavio Giordano
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
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13
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Abstract
In all levels of disc herniations the absolute surgical indications include deteriorating neurological deficits with myelopathy or cauda equina syndrome. However, this review summarized the relative indications for surgery in each level. In cervical disc herniation (CDH), the indications for surgery consist of six months of persisting symptoms, not responding to conservative treatment. However, high-quality studies are lacking, and a randomized controlled trial is now underway to clarify the indications. In thoracic disc herniation (TDH), the indications for surgery comprise failure of conservative measures and/or worsening neurological symptoms. Moreover, giant calcified thoracic disc herniations or myelopathy signs on magnetic resonance imaging, even in the absence of neurological symptoms, may benefit from surgical treatment as a preventive measure. In lumbar disc herniation (LDH), the indications for surgery include imaging confirmation of LDH, consistent with clinical findings, and failure to improve after six weeks of conservative care.
Cite this article: EFORT Open Rev 2021;6:526-530. DOI: 10.1302/2058-5241.6.210020
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Affiliation(s)
- Wai Weng Yoon
- Spinal Surgery Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.,Centre for Spinal Surgery, Queens Medical Centre, Nottingham University NHS Trust, Nottingham, UK
| | - Jonathan Koch
- Centre for Spinal Surgery, Queens Medical Centre, Nottingham University NHS Trust, Nottingham, UK
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14
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Kay RM, Pierz K, McCarthy J, Graham HK, Chambers H, Davids JR, Narayanan U, Novacheck TF, Rhodes J, Rutz E, Shilt J, Shore BJ, Veerkamp M, Shrader MW, Theologis T, Van Campenhout A, Dreher T. Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project. J Child Orthop 2021; 15:270-278. [PMID: 34211604 PMCID: PMC8223080 DOI: 10.1302/1863-2548.15.210044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method. METHODS The panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached. RESULTS Consensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade. CONCLUSION This study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Robert M. Kay
- Chilldren’s Hospital Los Angeles, Los Angeles, California, United States,Correspondence should be sent to: Robert M. Kay, MD, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd., #69, Los Angeles CA, United States 90027. E-mail:
| | - Kristan Pierz
- Connecticut Children’s Hospital, Hartford, Connecticut, United States
| | - James McCarthy
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | | | - Henry Chambers
- Rady Children’s Hospital, San Diego, California, United States
| | - Jon R. Davids
- Shriners Hospitals for Children-Northern California, Sacramento, California, United States
| | | | - Tom F. Novacheck
- Gillette Children’s Specialty Healthcare, Saint Paul, Minnesota, United States
| | - Jason Rhodes
- Children’s Hospital Colorado, Aurora, Colorado, United States
| | - Erich Rutz
- The Royal Children’s Hospital, Melbourne, Australia
| | - Jeffrey Shilt
- Texas Children’s Hospital, Houston, Texas, United States
| | | | - Matthew Veerkamp
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - M. Wade Shrader
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
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15
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Abstract
Background To evaluate the clinical characteristics and indications for surgery for
bezoar-induced small bowel obstruction (BI-SBO). Methods Forty patients with BI-SBO were treated at our hospital from January 2017 to
December 2019, and these patients’ clinical and computed tomography (CT)
data were analyzed. Results Twenty-seven and 13 BI-SBO patients constituted the non-ST group and ST
group, respectively. The clinical manifestations of BI-SBO in both groups
were abdominal pain, nausea, vomiting, and lack of defecation. Comparing the
non-ST vs ST groups, respectively: mean age (years): 63.15 ± 16.15 vs
60.38 ± 12.47; duration of symptoms (hours): 55.11 ± 44.08 vs 59.33 ± 72.90;
mean bezoar length (cm): 5.31 ± 0.74 vs 3.72 ± 0.53; mean bezoar width (cm):
3.74 ± 0.48 vs 2.9 ± 0.64; bezoar CT maximum Hounsfield units (HU):
97.23 ± 12.36 vs 21.11 ± 7.27; total hospital stay (days): 5.56 ± 4.23 vs
7.12 ± 6.12 (mean: 8.62 ± 2.81); and total hospitalization costs (RMB):
6378.02 ± 3015.68 vs 8213.71 ± 5564.29. Mean operation time was 85.00 ± 8.90
minutes, and mean operation blood loss was 32.31 ± 19.64 mL. Bezoars were
located 60 to 160 cm from the ileocecal junction. Univariate analysis
demonstrated that bezoar length and width and maximum CT value were
significant risk factors for surgery. Conclusion Large bezoar size and high CT values may be indications for surgery. Surgery
is necessary and effective when nonsurgical treatment is ineffective.
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Affiliation(s)
- Shuai Wang
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
| | - Xiaohui Yang
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
| | - Yixiong Zheng
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
| | - Yulian Wu
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
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16
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Abstract
Infective endocarditis (IE) remains a rare condition but one with high associated morbidity and mortality. With an ageing population and increasing use of implantable cardiac devices and heart valves, the epidemiology of IE has changed. Early clinical suspicion and a rapid diagnosis are essential to enable the correct treatment pathways to be accessed and to reduce complication and mortality rates. In the current review, we detail the latest guidelines for the evaluation and management of patients with endocarditis and its prevention.
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Affiliation(s)
- Ronak Rajani
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John L Klein
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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17
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Chen H, He Z, Li G, Liu C, Zhang D, Huang D, Xie C, Jiang W, Qiu Y, Zhang X, Liu Y. Endoscopy-Assisted Transoral Approach to Resect Parapharyngeal Space Tumors: A Systematic Review and Meta-Analysis. Laryngoscope 2021; 131:2246-2253. [PMID: 33616215 DOI: 10.1002/lary.29458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES By comparing the endoscopy-assisted transoral approach (EATA) with external approaches (EAs) for the resection of parapharyngeal space tumors (PPSTs), we determined whether the EATA has advantages in terms of operation time, intraoperative bleeding volume, postoperative hospitalization, drainage volume, and complications. At the same time, we summarized the surgical indications for the EATA. METHODS Systematic literature retrieval was performed in the PubMed, Web of Science, Embase, CNKI, Wanfang, and CQVIP databases up to February 2020. We calculated the mean difference (MD) with a 95% confidence interval (CI) for continuous outcomes and pooled odds ratio (OR) with 95% CI for dichotomous outcomes. The measured outcomes were operative time, bleeding volume, postoperative hospitalization, drainage volume, and complications. RESULTS Seven studies involving 318 patients were eligible. Of these patients, 145 patients underwent EATA and 173 patients underwent EA surgery. All the former tumors were benign and located medial or anteromedial to the carotid sheath except for the unrecorded tumors. Compared with EAs, the EATA significantly shortened the operation time (MD = -5.56 min, 95% CI: -9.58 to -1.55), shrank the bleeding volume (MD = -89.02 ml, 95% CI: -126.16 to -51.88), shortened the postoperative hospitalization (MD = -2.44 days, 95% CI: -3.37 to -1.51), reduced the drainage volume (MD = -32.97 ml, 95% CI: -36.24 to -29.70), and lowered the incidence of complications (OR = 0.30, 95% CI: 0.16 to 0.59). CONCLUSION As for PPSTs, with an appropriate and precise patient selection, the EATA is a safe, effective, minimally invasive, and aesthetic surgical modality. Laryngoscope, 2021.
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Affiliation(s)
- Huihong Chen
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
| | - Zhiying He
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
| | - Guo Li
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
| | - Chao Liu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
| | - Diekuo Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
| | - Donghai Huang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
| | - Changning Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
| | - Weihong Jiang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
| | - Yuanzheng Qiu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
| | - Xin Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Yong Liu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, People's Republic of China
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18
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Affiliation(s)
| | - Laurent Wehrli
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yael Maeder
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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19
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Rutz E, McCarthy J, Shore BJ, Shrader MW, Veerkamp M, Chambers H, Davids JR, Kay RM, Narayanan U, Novacheck TF, Pierz K, Rhodes J, Shilt J, Theologis T, Van Campenhout A, Dreher T, Graham K. Indications for gastrocsoleus lengthening in ambulatory children with cerebral palsy: a Delphi consensus study. J Child Orthop 2020; 14:405-414. [PMID: 33204348 PMCID: PMC7666804 DOI: 10.1302/1863-2548.14.200145] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Equinus is the most common deformity in cerebral palsy (CP) and gastrocsoleus lengthening (GSL) is the most commonly performed surgery to improve gait and function in ambulatory children with CP. Substantial variation exists in the indications for GSL and surgical technique. The purpose of this study was to review surgical anatomy and biomechanics of the gastrocsoleus and to utilize expert orthopaedic opinion through a Delphi technique to establish consensus for surgical indications for GSL in ambulatory children with CP. METHODS A 17-member panel, of Fellowship-trained paediatric orthopaedic surgeons, each with at least 9 years of clinical post-training experience in the surgical management of children with CP, was established. Consensus for the surgical indications for GSL was achieved through a standardized, iterative Delphi process. RESULTS Consensus was reached to support conservative Zone 1 surgery in diplegia and Zone 3 surgery (lengthening of the Achilles tendon) was contraindicated. Zone 2 or Zone 3 surgery reached general agreement as a choice in hemiplegia and under-correction was preferred to any degree of overcorrection. Agreement was reached that the optimum age for GSL surgery was 6 years to 10 years and should be avoided in children aged under 4 years. Physical examination measures with the child awake and under anaesthesia were important in decision making. Gait analysis was supported both for decision making and for assessing outcomes, in combination with patient reported outcomes (PROMS). CONCLUSIONS The results from this study may encourage informed practice evaluation, reduce practice variability, improve clinical outcomes and point to questions for further research. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Erich Rutz
- The Royal Children’s Hospital, Melbourne, Australia
| | - James McCarthy
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - M. Wade Shrader
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Matthew Veerkamp
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Jon R. Davids
- Shriners Hospitals for Children--Northern California, Sacramento, California, USA
| | - Robert M. Kay
- Children’s Hospital Los Angeles, Los Angeles, California, USA
| | | | - Tom F. Novacheck
- Gillette Children’s Specialty Healthcare, Saint Paul, Minnesota, USA
| | - Kristan Pierz
- Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | - Jason Rhodes
- Children’s Hospital Colorado, Aurora, Colorado, USA
| | | | | | | | | | - Kerr Graham
- The Royal Children’s Hospital, Melbourne, Australia,Correspondence should be sent to H. Kerr Graham, Department of Orthopaedic Surgery, Royal Children’s Hospital, Flemington Road, Parkville, Victoria, Australia. E-mail:
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20
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Abstract
BACKGROUND Patient selection for cervical disc arthroplasty (CDA) in the United States remains a topic of debate among surgeons. Many surgeons base US patient selection for CDA implantation on the Food and Drug Administration (FDA) indications/contraindications. While off-label use does occur, the frequency and extent of off-label use in the US remains largely unknown. Outside the United States, patient selection is notably less stringent; however such data also remain largely unpublished or presented/published with a low level of evidence. Here, we will review the current approved US on-label patient selection criteria for CDA and discuss the rationale and supporting evidence to expand these criteria in the United States. METHODS A PubMed literature search was completed using the keywords "cervical disc arthroplasty" and "cervical disc replacement." The articles were evaluated by the authors for patient selection criteria. CONCLUSIONS The current published data do not conclusively prove that the patients excluded from CDA by strict adherence to FDA indications would benefit from CDA surgery over anterior cervical discectomy and fusion. As surgeons, it is a difficult decision regarding when to expand indications to include off-label use of CDA. In our practice, generally CDA patient selection agrees with the FDA indications and contraindications, as there is a lack of level 1 evidence to confirm effectiveness of CDA outside of the current FDA indications. We will likely need more well-constructed studies to include prospective and controlled trials that specifically evaluate the "off-label" applications before US surgeons are convinced to expand indications and insurance companies agree to reimburse.
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Affiliation(s)
| | - Kelly Frank
- Spine Institute of Louisiana, Shreveport, Louisiana
| | - Marcus Stone
- Spine Institute of Louisiana, Shreveport, Louisiana
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21
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McCarthy J, Wade Shrader M, Graham K, Veerkamp M, Brower L, Chambers H, Davids JR, Kay RM, Narayanan U, Novacheck TF, Pierz K, Rhodes J, Rutz E, Shilt J, Shore BJ, Theologis T, Van Campenhout A. Establishing surgical indications for hamstring lengthening and femoral derotational osteotomy in ambulatory children with cerebral palsy. J Child Orthop 2020; 14:50-57. [PMID: 32165981 PMCID: PMC7043128 DOI: 10.1302/1863-2548.14.190173] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/06/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Surgical procedures, such as medial hamstring lengthening (MHL) and femoral derotational osteotomy (FDO), can improve the gait of children with cerebral palsy (CP); however, substantial variation exists in the factors that influence the decision to perform surgery. The purpose of this study was to use expert surgeon opinion through a Delphi technique to establish consensus for indications in ambulatory children with CP. METHODS A 15-member panel, all established experts with at least nine years' experience in the surgical management of children with CP, was created (mean of 20.81 years' experience). All panel members also had expertise of the use of movement analysis for the assessment of gait disorders in children with CP. The group initially focused on two of the most commonly performed procedures, MHL and FDO, in an attempt to gain consensus (> 80%). This was obtained through a standardized, iterative Delphi process. RESULTS For MHL, a total of 59 questions were surveyed: 41 indication questions and 18 outcome questions, for which there was consensus on ten indication questions and seven outcomes. For FDO, a total of 55 questions were surveyed: 43 indication questions and 12 outcome questions, for which there was consensus on 29 indication questions and eight outcomes. CONCLUSION This study is the first to use an expert panel to identify best-practice indications for common surgical procedures of children with CP. The results from this study will allow for more informed evaluation of practice and form the basis for future improvement efforts to standardize surgical recommendations internationally. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- James McCarthy
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - M. Wade Shrader
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
| | - Kerr Graham
- The Royal Children’s Hospital, Melbourne, Australia
| | - Matthew Veerkamp
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - Laura Brower
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
| | - Hank Chambers
- Rady Children’s Hospital, San Diego, California, United States
| | - Jon R. Davids
- Shriners Hospitals for Children-Northern California, Sacramento, California, United States
| | - Robert M. Kay
- Children’s Hospital Los Angeles, Los Angeles, California, United States
| | - Unni Narayanan
- The Hospital for Sick Children, Toronto, Canada, United States
| | - Tom F. Novacheck
- Gillette Children’s Specialty Healthcare, Saint Paul, Minnesota, United States
| | - Kristan Pierz
- Connecticut Children’s Hospital, Hartford, Connecticut, United States
| | - Jason Rhodes
- Children’s Hospital Colorado, Aurora, Colorado, United States
| | - Erich Rutz
- University Children’s Hospital Basle, Basle, Switzerland
| | - Jeffery Shilt
- Texas Children’s Hospital, Houston, Texas, United States
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22
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Keener JD, Patterson BM, Orvets N, Chamberlain AM. Degenerative Rotator Cuff Tears: Refining Surgical Indications Based on Natural History Data. J Am Acad Orthop Surg 2019; 27:156-65. [PMID: 30335631 DOI: 10.5435/JAAOS-D-17-00480] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Degenerative rotator cuff tears are the most common cause of shoulder pain and have a strong association with advanced aging. Considerable variation exists in surgeons' perceptions on the recommended treatment of patients with painful rotator cuff tears. Natural history studies have better outlined the risks of tear enlargement, progression of muscle degeneration, and decline in the function over time. This information combined with the known factors potentially influencing the rate of successful tendon healing such as age, tear size, and severity of muscle degenerative changes can be used to better refine appropriate surgical indications. Although conservative treatment can be successful in the management of many of these tears, risks to nonsurgical treatment also exist. The application of natural history data can stratify atraumatic degenerative tears according to the risk of nonsurgical treatment and better identify tears where early surgical intervention should be considered.
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23
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24
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Woller Iii JA, Walsh VL, Robichaux C, Thourani VH, Jacob JT. Predictors of Surgical Intervention in Dialysis Patients With Infective Endocarditis. Open Forum Infect Dis 2018; 5:ofy265. [PMID: 30539033 PMCID: PMC6280940 DOI: 10.1093/ofid/ofy265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/18/2018] [Indexed: 11/12/2022] Open
Abstract
Background The use of valve surgery for infective endocarditis (IE) in end-stage renal disease (ESRD) patients may be different than in the general population. We assessed predictors of early surgery in ESRD patients with IE. Methods We conducted a retrospective cohort study among dialysis patients with left-sided IE between 2005 and 2015. Indications for surgery were based on current endocarditis guidelines. Patients were categorized as early valve replacement surgery or delayed/no surgery. We used logistic regression to determine independent predictors of early surgery. Results Among 229 patients, 67 (29.3%) underwent early surgery. New congestive heart failure was the only high level of evidence indication independently associated with early surgery (odds ratio [OR], 12.1; 95% confidence interval [CI], 3.4-43.6). Transfer from outside hospital (OR, 5.4; 95% CI, 2.2-13.3), valve rupture (OR, 6.9; 95% CI, 2.6-17.9), coagulase-negative staphylococcus etiology (OR, 3.8; 95% CI, 1.4-10.6), and presence of any low level of evidence indication (OR, 5.9; 95% CI, 2.2-15.5) predicted early surgery. Preexisting valve disease (OR, 0.31; 95% CI, 0.12-0.82) and surgical contraindications (OR, 0.05; 95% CI, 0.005-0.4) predicted nonsurgical treatment. Conclusions Among ESRD patients with IE, most surgical indications are not predictive of early surgery.
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Affiliation(s)
- John A Woller Iii
- Emory University School of Medicine, Atlanta, Georgia.,Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Victoria L Walsh
- Division of Infectious Diseases, Atlanta, Georgia.,Department of Medicine, Atlanta, Georgia.,Emory University School of Medicine, Atlanta, Georgia
| | - Chad Robichaux
- Department of Medicine, Atlanta, Georgia.,Emory University School of Medicine, Atlanta, Georgia
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart & Vascular Institute, MedStar Health, Columbia, Maryland
| | - Jesse T Jacob
- Division of Infectious Diseases, Atlanta, Georgia.,Department of Medicine, Atlanta, Georgia.,Emory University School of Medicine, Atlanta, Georgia
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Somerson JS, Hsu JE, Neradilek MB, Matsen FA 3rd. The "tipping point" for 931 elective shoulder arthroplasties. J Shoulder Elbow Surg 2018; 27:1614-21. [PMID: 29748122 DOI: 10.1016/j.jse.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/01/2018] [Accepted: 03/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND A patient with arthritis usually experiences the progression of symptoms over time. At some stage, the patient may decide that the symptoms have reached a level of severity that leads him or her to elect to proceed with joint replacement; we refer to this degree of symptom severity as the "tipping point." Our goal was to study the factors that influenced the tipping point for patients undergoing elective shoulder arthroplasty. METHODS We analyzed the characteristics of 931 patients undergoing shoulder arthroplasty to determine the factors affecting the tipping point as characterized by the patients' comfort and function at the time they determined their symptoms had progressed to the point when this elective surgery was merited. RESULTS The preoperative Simple Shoulder Test (SST) score for all patients averaged 3.6 ± 2.7. The average tipping points were different for the ream-and-run procedure (mean SST score, 5.0 ± 2.5), hemiarthroplasty (mean SST score, 3.1 ± 3.3), total shoulder arthroplasty (mean SST score, 3.0 ± 2.4), cuff tear arthropathy arthroplasty (mean SST score, 2.8 ± 2.5), and reverse total shoulder arthroplasty (mean SST score, 1.5 ± 1.8). A number of other factors were significantly associated with a higher tipping point: younger age, better health, male sex, commercial insurance, married, nonuse of narcotics, use of alcohol, and shoulder problem not related to work. CONCLUSIONS Analysis of the tipping point-the patients' self-assessed comfort and function at the point they decide to undergo shoulder joint replacement-provides a means by which surgeons can understand the factors influencing the indications for these procedures.
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Abstract
Background: Reviewing the neurosurgical literature demonstrated that spinal neurosurgeons rarely (0.78%) diagnose chiari-1 malformation (CM-1) in adults on magnetic resonance (MR) studies defined by tonsillar descent >5 mm below the foramen magnum (FM). Children, averaging 10 years of age, exhibit CM-1 in 96/100,000 cases. According to the literature, fewer spinal neurosurgeons additionally recognize and treat the low lying cerebellar tonsil (LLCT) syndrome. Methods: The normal location of the cerebellar tonsils on cranial/cervical MR averages 2.9 mm ± 3.4 mm above or up to 3 mm below the FM. The neurosurgical literature revealed that most neurosurgeons diagnose and treat CM-1 where the tonsils are >5 mm to an average of 12 mm below the FM. Fewer spinal neurosurgeons additionally diagnose and treat the LLCT syndrome defined by <5 mm of tonsillar descent below the FM. Results: According to the neurosurgical literature, many neurosurgeons perform cranial/spinal decompression with/without fusion and/or duraplasty for CM-1. Fewer neurosurgeons perform these procedures for CM-1 and the LLCT syndrome, for which they additionally perform preoperative cervical traction under anesthesia, and the postoperative placement of occipital neurostimulators (ONS) for intractable headaches following chiari-1/LLCT surgery. Conclusion: Reviewing the literature revealed that spinal neurosurgeons rarely diagnose CM-1, and treat them with decompressions with/without fusions and/or duraplasty. Fewer spinal neurosurgeons diagnose/treat both the CM-1 and LLCT syndromes, perform preoperative traction under anesthesia, and place ONS for persistent headaches following CM-1 surgery.
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Affiliation(s)
- Nancy E Epstein
- Professor of Clinical Neurosurgery, School of Medicine, State University of N.Y. at Stony Brook, New York, USA.,Chief of Neurosurgical Spine and Education NYU Winthrop Hospital, NYU Winthrop NeuroScience, Mineola, New York, USA
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Ursales A, Klein JA, Beal SG, Koch M, Clement-Kruzel S, Melton LB, Spak CW. Antibiotic failure in a renal transplant patient with Rhodococcus equi infection: an indication for surgical lobectomy. Transpl Infect Dis 2014; 16:1019-23. [PMID: 25412764 DOI: 10.1111/tid.12314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/03/2014] [Accepted: 09/11/2014] [Indexed: 12/18/2022]
Abstract
Rhodococcus equi is an animal pathogen that causes infrequent but challenging infections in immunocompromised individuals, few of which have been described in solid organ transplant recipients. Common clinical presentations include indolent cough, fever, and dyspnea, with necrotizing pneumonia and cavitation. We report a case of a dense right upper lung pneumonia with resultant R. equi bacteremia in a renal transplant recipient. Our patient initially responded to antibiotic treatment with resolution of bacteremia and clinical recovery, followed by interval progression in her right upper lobe consolidation on follow-up computed tomography scans. She underwent lobectomy for definitive therapy with resolution of symptoms. Lobectomy can be utilized in isolated infection after antibiotic failure with excellent clinical outcomes.
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Affiliation(s)
- A Ursales
- Department of Medicine, Division of Infectious Diseases, Baylor University Medical Center, Dallas, Texas, USA
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Mitsukawa N, Saiga A, Satoh K. Protocol of surgical indications for scar contracture release before childbirth: women with severe abdominal scars after burn injuries. J Plast Surg Hand Surg 2014; 49:32-5. [PMID: 25141290 DOI: 10.3109/2000656x.2014.942314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
It is difficult to determine if women with severe abdominal burn scar contractures can have uneventful pregnancies and births. There are few reports involving the relationship between severe abdominal scar contractures and pregnancy/childbirth. Furthermore, all of these reports are based on retrospective studies. The present study focused on women with severe abdominal burn scar contractures with desired fertility. This study investigated whether or not normal childbirth is possible, the necessity of scar contracture release, and the delivery method. In addition, a protocol developed by this hospital was prospectively evaluated. Surgery was indicated in women with scars covering ≥75% of the total abdominal area. The scarred area in the upper abdomen, superior to the navel, was considered particularly important. The protocol of this study serves merely as a reference, and future studies are needed with an increased number of cases.
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Affiliation(s)
- Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine , Chiba , Japan
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Abstract
INTRODUCTION Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. Currently, for any incidentally discovered Meckel's diverticulum, the management approach is based on weighing the statistical odds of future complications against the risks of a diverticulectomy. MATERIALS AND METHODS The temporal relationship between age at Meckel's diverticulectomy and the presence of ectopic epithelium was evaluated in our series. A meta-analysis of all reported recent literature on this condition was subsequently performed to evaluate the strength of the relationship between ectopic epithelium and symptomatic Meckel's diverticulum. RESULTS There was a paucity of ectopic epithelium in Meckel's diverticulectomy specimens in infants operated on at less than 1 year of age. Having two or more ectopic epithelia in a diverticulum does not appear to carry an additive risk for complications. The meta-analysis confirmed that ectopic epithelium was the most significant factor that influenced surgical intervention in all series of Meckel's diverticulum. CONCLUSION The relationship between ectopic epithelium and the development of symptomatic Meckel's diverticulum is complex. Further understanding of the development of ectopic rests in the diverticulum will facilitate elucidating the pathophysiology in symptomatic cases.
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Affiliation(s)
- Sathyaprasad Burjonrappa
- Department of Pediatric Surgery, Children's Hospital of New Jersey and Beth Israel Medical Center, Newark, USA
| | - Phue Khaing
- Medical Student, The University of Medicine and Dentistry of New Jersey, NJ, USA
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Zhong Y, Zhu D, Liang L, Ye Q, Wei Y, Ren L, Pan X, Fan J, Xu J, Qin X. The results of surgery for colorectal hepatic metastases following expansion of the indications in 2005. Colorectal Dis 2013; 15:e429-34. [PMID: 23663516 DOI: 10.1111/codi.12275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 12/13/2012] [Accepted: 01/13/2013] [Indexed: 02/08/2023]
Abstract
AIM Safety and survival were investigated in patients treated according to expanded surgical indications for colorectal hepatic metastases. METHOD A retrospective analysis of all consecutive patients who underwent resection of colorectal hepatic metastases at Zhongshan Hospital from 2000 to 2010 was conducted. The patients were divided into two groups based on a change in the surgical indications introduced in 2005. Patients in Group I underwent hepatic surgery between 2000 and 2004 and those in Group II between 2005 and 2010. The clinicopathological data and survival rates of both groups were analysed. RESULTS There were 530 patients who underwent hepatic surgery between 2000 and 2010. After the expansion of surgical indications, the rate of surgical resection rose from 25.1 to 35.1% (P < 0.05). There was no significant difference in perioperative mortality (2.2% vs 0.9%) or morbidity (20.9% vs 29.8%). Recurrence occurred in 27.5% and 36.7% in Groups I and II, respectively, and 5-year overall survival was 43% and 49%, respectively (not significant). CONCLUSION Expanding the indications for surgical resection of hepatic metastases increased the resection rate but had no significant effect on survival.
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Affiliation(s)
- Y Zhong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Abstract
Background: The diagnosis and management of Chiari I malformations (CMI) remains controversial, particularly since it is often an incidental finding on cervical MR scans performed for neck pain and/or headaches. Recently, some surgeons “over-operated” on asymptomatic patients with Chiari I malformations, or even on those without the requisite radiographic diagnostic features for Chiari I malformations: unfortunately, only a subset were admonished for indiscriminate surgery. Nevertheless, when this hindbrain malformation is truly symptomatic, contributing to impaired cerebrospinal fluid (CSF) circulation, various valid surgical management strategies may be adopted. Methods: This review focuses on the current literature regarding the clinical presentation, diagnosis, and surgical management of Chiari I malformation. Variations in the surgical technique are also presented and critiqued. Results: The recommended treatment for Chiari I malformations I consists of decompressive suboccipital craniectomy and duroplasty when abnormal cine-flow MRI is observed preoperatively and blockage of CSF flow persists intraoperatively despite bony decompression. Conclusions: Controversy continues regarding the optimal surgical technique to address Chiari malformations I. Proper diagnostic studies and patient selection are needed to optimize patient outcomes, while avoiding unnecessary surgical procedures.
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Affiliation(s)
- Jamie Baisden
- Department of Neurosurgery, The Medical College of Wisconsin, Milwaukee, WI, USA
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Abstract
BACKGROUND/OBJECTIVE Tarlov cysts or spinal perineurial cysts are uncommon lesions. These are mostly incidental findings on magnetic resonance imaging or myelograms. The objectives of this study were to describe Tarlov cysts of the sacral region as a potential cause for retrograde ejaculations and review available management options. METHODS Case report and literature review. RESULTS A 28-year-old man presented with back pain and retrograde ejaculations resulting in infertility. After microsurgical excision of large perineurial cysts, back pain resolved, but semen quality showed only marginal improvement. Later, the couple successfully conceived by intrauterine insemination. To the best of our knowledge, this is the first reported case of Tarlov cyst associated with retrograde ejaculation and infertility. CONCLUSIONS Despite being mostly asymptomatic and an incidental finding, Tarlov cyst is an important clinical entity because of its tendency to increase in size with time. Tarlov cysts of the sacral and cauda equina region may be a rare underlying cause in otherwise unexplained retrograde ejaculations and infertility. Microsurgical excision may be a good option in a select group of patients.
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Affiliation(s)
- Pankaj Kumar Singh
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.
| | - Vinay Kumar Singh
- 2Orthopaedics and Spinal Surgery, Luton and Dunstable Hospital, Luton, United Kingdom
| | - Amir Azam
- 3Trauma, Orthopaedics and Spinal Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
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