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Díaz Del Arco C, Ortega Medina L, Estrada Muñoz L, Molina Roldán E, García Gómez de Las Heras S, Fernández Aceñero MJ. Prognostic role of the number of resected and negative lymph nodes in Spanish patients with gastric cancer. Ann Diagn Pathol 2023; 67:152209. [PMID: 37689040 DOI: 10.1016/j.anndiagpath.2023.152209] [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: 08/29/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Lymph node (LN) involvement is one of the most critical prognostic factors in resected gastric cancer (GC). Some analyses, mainly conducted in Asian populations, have found that patients with a higher number of total lymph nodes (NTLN) and/or negative lymph nodes (NNLN) have a better prognosis, although other authors have failed to confirm these results. MATERIALS AND METHODS Retrospective study including all patients with GC resected in a tertiary hospital in Spain between 2001 and 2019 (n = 315). Clinicopathological features were collected and patients were categorized according to the NTLN and the NNLN. Statistical analyses were performed. RESULTS Mean NNLN was 17. The NNLN was significantly related to multiple clinicopathological variables, including recurrence and tumor-related death. The classification based on the NNLN (N1: ≥16, N2: 8-15, N3: ≤7) effectively stratified the entire cohort into three distinct prognostic groups and maintained its prognostic value within both the pN0 and pN+ patient subsets. Furthermore, it was an independent prognostic indicator for both overall and disease-free survival. Conversely, the mean NTLN was 21.9. Patients with ≤16 LN retrieved exhibited distinct clinicopathological features compared to those with >16 LN, but no significant differences were observed in terms of recurrence or disease-associated death. The application of alternative cut-off points for NTLN (10, 20, 25, 30, and 40) showed no prognostic significance. CONCLUSIONS In Spanish patients with resected GC the NNLN hold prognostic significance, while the NTLN does not appear to be prognostically significant. Incorporating the NNLN into GC staging may enhance the accuracy of the TNM system.
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Affiliation(s)
- Cristina Díaz Del Arco
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Luis Ortega Medina
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Lourdes Estrada Muñoz
- Department of Basic Medical Sciences, School of Medicine, Rey Juan Carlos University, Móstoles, Madrid, Spain; Department of Pathology, Rey Juan Carlos Hospital, Móstoles, Madrid, Spain
| | - Elena Molina Roldán
- Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Biobank, Hospital Clínico San Carlos, Madrid, Spain
| | | | - M Jesús Fernández Aceñero
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Alben MG, Gambhir N, Kingery MT, Halpern R, Papalia AG, Kwon YW, Zuckerman JD, Virk MS. No difference in complications between two-week vs. six-week duration of sling immobilization after reverse total shoulder arthroplasty. JSES Int 2023; 7:2486-2491. [PMID: 37969500 PMCID: PMC10638591 DOI: 10.1016/j.jseint.2023.07.015] [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] [Indexed: 11/17/2023] Open
Abstract
Background The purpose of our study was to compare the outcomes and complications after a two- vs. six-week duration of sling immobilization following reverse total shoulder arthroplasty (rTSA). Methods We conducted a retrospective review from our institutional database on 960 patients treated by primary rTSA between 2011 and 2021. Patients were separated into two cohorts of postoperative sling immobilization (a two-week and six-week group). Multivariate analysis was conducted to evaluate what factors were associated with patients experiencing either a postoperative complication or requiring reoperation. Results A total of 276 patients were instructed to keep their operative arm in a sling for six weeks postoperatively, and 684 patients discontinued use at two weeks. There was no difference in postoperative complication rate (15.0% vs. 12.0%, P = .21), dislocation rate (P = .79), acromion stress fractures (P = .06), implant loosening (P = .15), and periprosthetic joint infections (P = .48) between the six- and two-week sling cohorts. In the immediate 90-day postoperative time period, no difference was seen in the reoperation rates (P = .73). Discussion Shorter duration of sling immobilization (two weeks) does not incur additional risk of complications compared to standard duration (six weeks) of sling immobilization following rTSA.
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Affiliation(s)
- Matthew G. Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew T. Kingery
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Robert Halpern
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Aidan G. Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Young W. Kwon
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D. Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S. Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Xie X, Li K, Xiang B. Total versus conventional robotic-assisted cyst excisions and hepaticojejunostomies in children with choledochal cysts: a case-control study. J Robot Surg 2023; 17:869-876. [PMID: 36324048 DOI: 10.1007/s11701-022-01484-9] [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] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/16/2022] [Indexed: 05/25/2023]
Abstract
The current study's primary aim is to compare the safety and effectiveness between total and conventional robot-assisted cyst excisions and hepaticojejunostomies in children with choledochal cysts (CCs). Patients suffering from CCs treated with either total or conventional robot-assisted procedures (TRAS or CRAS) between December 2019 and February 2021 were analyzed retrospectively. Data collected included the characteristics, operative and postoperative details. The risk factors for conversion of TRAS to CRAS were analyzed by logistic regression analysis. There were 50 patients who underwent TRAS and CRAS, respectively, and 19 patients were transferred to CRAS. The operation time in the TRAS group was significantly higher than that of the CRAS group, while the time to taking water and hospital stay were significantly shorter (p < 0.05). No significant difference was observed in complications between the groups (p = 0.325). The risk factors for conversion of TRAS to CRAS were age ≥ 48 months, thickness of abdominal wall (TAW) ≥ 1.3 cm and upper abdominal length (UAL) ≥ 9.5 cm. Both TRAS and CRAS are safe and feasible. Performing TRAS is recommended for patients whose age ≥ 48 months, TAW ≥ 1.3 cm and UAL ≥ 9.5 cm, while for others, it is recommended to perform CRAS.
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Affiliation(s)
- Xiaolong Xie
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, Sichuan Province, China
| | - Kewei Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, Sichuan Province, China.
| | - Bo Xiang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, Sichuan Province, China.
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de Cano JJM, Trias E. THE CEMENTED DOUBLE MOBILITY CUP IN HIP REVISION: DIFFERENT POSSIBILITIES OF USE. Acta Ortop Bras 2023; 31:e256913. [PMID: 37082167 PMCID: PMC10112351 DOI: 10.1590/1413-785220233101e256913] [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] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/10/2022] [Indexed: 04/22/2023]
Abstract
Introduction The aim of our work is to review those patients who underwent prosthetic hip revision surgery in our hospital considered to be patients at high risk of dislocation or recurrent dislocation, and who underwent a double mobility cemented cup (CMD). Analyzing the different ways to place these cups and the clinical results and reluxations. Material and methods The 69 cases comprised 34 men and 35 women with a mean age of 77,39 years. The mean follow-up was 4.7536 years. The type of intervention performed varied according to the cause of the intervention, the acetabular bone stock and the state of the primary cup. In the cases in which there was a good fixation of the primary metalback, we opted to carry out a cementation of the cemented DMC into the existing well-fixed metal acetabular shell, this occurred in 23 cases. In the cases where there was loosening of the primary cup but there was a good bone stock, a CMD was cemented into the bone (21 cases). In the cases where there was a Paprosky type III we cemented a DMC to a Bursch-Schneider reinforcement ring together with the placement of a cancellous bone graft (25 cases). Results The clinical evaluation at the end of the follow-up, according to the MD Scale, showed the mean value was 16.454 (SD 0.79472), with a survival at the end of the follow-up of 100% of the placed DMC. Conclusion The use of cemented DMC is a good solution in the replacement of THA, especially in cases of reluxation or risk of dislocation due to personal or technical predisposing factors. The use of these DMC cemented can be directly to the bone, into the existing well-fixed metal Shell, or cemented to a reinforcing ring, depending on the acetabular defect. Evidence Level III; Comparative Case Series .
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Johnson LG, Anastasio AT, Fletcher AN, Hendren S, Adams SB. Outcomes following total talus replacement: A systematic review. Foot Ankle Surg 2022; 28:1194-1201. [PMID: 36028440 DOI: 10.1016/j.fas.2022.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/15/2022] [Revised: 07/30/2022] [Accepted: 08/17/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The treatment of pathologic changes to the talus and surrounding joints presents a unique challenge to the foot and ankle surgeon. The purpose of this systematic review is to summarize the literature for unconstrained (no surrounding fusion or replacement) total talus replacement (TTR) and evaluate whether it leads to improved clinical and radiographic outcomes and appropriate safety metrics. METHODS Concepts of talus and arthroplasty were searched in MEDLINE, Embase, CINAHL Complete, and Scopus from 2005 to 2021. Inclusion Criteria were 1) previous trauma to the talus, 2) post-traumatic or degenerative arthritis to the tibiotalar joint, 3) avascular necrosis of talus, 4) multiple failed prior interventions, and 5) inflammatory arthropathy to tibiotalar joint. Manuscripts in non-English languages or those with concomitant total ankle arthroplasty or revision arthroplasty were excluded. RESULTS Twenty-two studies of 191 patients (196 ankles) were included. Nineteen studies utilized third generation implants, two studies used first generation (n = 9) and one study used second generation implants (n = 14) made largely of ceramic (n = 84), cobalt chrome (n = 49), or titanium (n = 24). Patient-reported outcome measures were favorable in all described categories (Table 4) with ten studies reporting an average postoperative change of + 2.92° of dorsiflexion and - 2.05° plantarflexion at final follow-up. The most common adverse outcome was adjacent joint arthritis with five studies reporting some degree of postoperative, degenerative changes in the surrounding joints (n = 52). CONCLUSION TTR is an alternative to joint sacrificing procedures to maintain range of motion through the tibiotalar joint and allow for maintenance of normal foot and ankle biomechanics. Despite promising early- and mid-term outcomes, future, prospective, randomized research should be conducted to better assess survivorship and complication rates with direct comparison of TTR to existing forms of salvage options for advanced talar pathology. LEVEL OF EVIDENCE III, Systematic Review of Level IV Studies.
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Affiliation(s)
- Lindsey G Johnson
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | | | | | | | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Kihara K, Koyama Y, Hanaki T, Miyatani K, Matsunaga T, Yamamoto M, Morizane S, Tokuyasu N, Sakamoto T, Fujiwara Y. Robot-assisted total pelvic exenteration for rectal cancer after neoadjuvant chemoradiotherapy: a case report. Surg Case Rep 2022; 8:191. [PMID: 36205818 PMCID: PMC9547043 DOI: 10.1186/s40792-022-01547-x] [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: 05/14/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Background There are numerous indications for minimally invasive surgery. However, the laparoscopic approach for extended pelvic surgery is currently provided by only a few institutions specializing in cancer treatment, primarily because of technical difficulties that arise in cases involving a narrow pelvis and rigid forceps. We report a case of robot-assisted total pelvic exenteration for rectal cancer involving the prostate. We assessed the feasibility of robot-assisted total pelvic exenteration and compared the short-term outcomes of other conventional and minimally invasive approaches. Case presentation A 67-year-old man was referred to our hospital after positive fecal blood test results. The initial diagnosis was clinical T4bN2aM0, Stage IIIC rectal cancer involving the prostate. The patient underwent neoadjuvant chemoradiotherapy. Consequently, robot-assisted total pelvic exenteration with an ileal conduit and end colostomy creation were performed. The total operative duration was 9 h and 20 min. The durations of robot console usage by the colorectal and urological teams were 2 h 9 min and 2 h 23 min, respectively. The patient was discharged on postoperative day 21. The pathological diagnosis was T4b (prostate) N0M0, Stage IIC. The resection margin was 2.5 mm. During reassessment at 2 years after resection, no evidence of recurrence was observed. Conclusions Robot-assisted total pelvic exenteration was performed for a patient with advanced rectal cancer without serious complications. Robot-assisted total pelvic exenteration may provide the advantages of minimally invasive surgery, particularly in the enclosed space of the pelvis.
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Affiliation(s)
- Kyoichi Kihara
- grid.265107.70000 0001 0663 5064Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago City, Tottori 683-8504 Japan
| | - Yuri Koyama
- grid.265107.70000 0001 0663 5064Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago City, Tottori 683-8504 Japan
| | - Takehiko Hanaki
- grid.265107.70000 0001 0663 5064Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago City, Tottori 683-8504 Japan
| | - Kozo Miyatani
- grid.265107.70000 0001 0663 5064Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago City, Tottori 683-8504 Japan
| | - Tomoyuki Matsunaga
- grid.265107.70000 0001 0663 5064Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago City, Tottori 683-8504 Japan
| | - Manabu Yamamoto
- grid.265107.70000 0001 0663 5064Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago City, Tottori 683-8504 Japan
| | - Shuichi Morizane
- grid.265107.70000 0001 0663 5064Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago City, Tottori 683-8504 Japan
| | - Naruo Tokuyasu
- grid.265107.70000 0001 0663 5064Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago City, Tottori 683-8504 Japan
| | - Teruhisa Sakamoto
- grid.265107.70000 0001 0663 5064Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago City, Tottori 683-8504 Japan
| | - Yoshiyuki Fujiwara
- grid.265107.70000 0001 0663 5064Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago City, Tottori 683-8504 Japan
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Poff C, Kunkle B, Li X, Friedman RJ, Eichinger JK. Assessing the hospital volume-outcome relationship in total elbow arthroplasty. J Shoulder Elbow Surg 2022; 31:367-374. [PMID: 34592413 DOI: 10.1016/j.jse.2021.08.025] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasty (TEA) is an effective intervention for multiple elbow disorders including complex fracture in elderly patients, post-traumatic arthropathy, inflammatory arthropathy, and distal humeral nonunion. Given its known therapeutic value and low utilization rate, an investigation into the thresholds for TEA institutional volume-outcome relationships is warranted. The purpose of this study was to identify TEA volume thresholds that serve as predictors of institutional outcomes including complications, readmissions, revisions, cost of care, length of stay (LOS), and non-home discharge. We hypothesized that increased institutional volume would be associated with decreased 90-day adverse outcomes and resource utilization. METHODS The Nationwide Readmission Database was queried from 2010 to 2017 to identify all cases of TEA. Hospital volume was calculated using a unique hospital identifier and divided into quartiles. Outcomes such as complications, readmissions, revisions, cost of care, LOS, and non-home discharge were then analyzed by quartile. The same outcomes were assessed via stratum-specific likelihood ratio (SSLR) analysis to define volume strata among institutions. RESULTS SSLR analysis defined statistically significant hospital volume categories for each 90-day outcome. The volume category with the lowest complication rate was ≥21 TEAs per year (5.6%). The volume categories with the lowest readmission rates were 1-3 TEAs per year (4.7%) and ≥18 TEAs per year (9.2%). Revision rates were lowest in the volume categories of 1-5 TEAs per year (0.1%) and ≥18 TEAs per year (0.1%). Hospitals with ≥21 TEAs per year had the lowest cost of care and the highest rate of extended LOS (>2 days). SSLR analysis showed that non-home discharges decreased in a stepwise manner as volume increased. The lowest non-home discharge rate was associated with the volume category of ≥22 TEAs per year (20.3%). CONCLUSION This study defines TEA volume strata for institutional outcomes. The highest TEA volume strata were associated with the lowest rates of 90-day complications, revisions, and non-home discharges and the lowest cost of care. This trend is likely attributable to the benefits of high-volume institutional experience and standardized patient-care processes.
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Affiliation(s)
- Charles Poff
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Bryce Kunkle
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Richard J Friedman
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Josef K Eichinger
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA.
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Berliner ZP, Novikov D, Ergin C, Aurigemma PH. Knee-Spanning External Fixation for Recurrent Traumatic Anterior Prosthetic Knee Dislocation With Associated Vascular Injury. Arthroplast Today 2021; 10:160-165. [PMID: 34401420 PMCID: PMC8358105 DOI: 10.1016/j.artd.2021.06.017] [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: 02/14/2021] [Revised: 06/16/2021] [Accepted: 06/19/2021] [Indexed: 12/01/2022] Open
Abstract
Traumatic anterior prosthetic knee dislocation after total knee arthroplasty is a rare event. We report the case of an 88-year-old female who presented with right traumatic anterior knee dislocation and concurrent popliteal artery injury requiring an emergent bypass graft. Postoperatively, the patient had redislocated her prosthetic knee, requiring urgent re-reduction and stabilization with an external fixator. We review her case, as well as additional reported cases of anterior knee dislocation. We also review the clinical considerations surrounding arterial injury, vascular bypass, and external fixation as a proposed management in unstable cases refractory to bracing.
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Affiliation(s)
- Zachary P Berliner
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
| | - David Novikov
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
| | - Colleen Ergin
- Department of Orthopaedic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Phillip H Aurigemma
- Department of Orthopaedic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
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Bahat G, Catikkas NM, Karan MA. Skeletal muscle mass assessment to detect low muscle mass: Regional or total? Clin Nutr 2021; 40:4642-4643. [PMID: 34229270 DOI: 10.1016/j.clnu.2021.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/09/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Gulistan Bahat
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Capa, 34093, Istanbul, Turkey.
| | - Nezahat Muge Catikkas
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Capa, 34093, Istanbul, Turkey
| | - Mehmet Akif Karan
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Capa, 34093, Istanbul, Turkey
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Moslim MA, Handorf E, Reddy SS, Greco SH, Farma JM. Partial Gastrectomy is Associated with Improved Overall Survival in Signet-Ring Cell Gastric Cancer. J Surg Res 2021; 266:27-34. [PMID: 33975027 DOI: 10.1016/j.jss.2021.04.005] [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] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/08/2021] [Accepted: 04/01/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Signet-ring cell gastric cancer (SRGC) is a histological variant of gastric adenocarcinoma (GAC) with a worse prognosis compared to non-signet-ring cell gastric cancer (NSRGC). To our knowledge, the overall survival (OS) among patients with SRGC undergoing total/near-total (TG) versus partial gastrectomy (PG) has never been reported from a large-scale Western database. METHODS We performed a retrospective analysis of patients with both SRGC and NSRGC using The National Cancer Database. RESULTS In total, 17,086 patients were included. Patients who underwent TG versus PG were 25.5% (n = 770) versus 74.5% (n = 2246) for SRGC, and 20.9% (n = 2943) versus 79.1% (n = 11,127) for NSRGC, respectively. Patients who had SRGC were more likely to undergo TG (25.5% versus 20.9% P< 0.0001). Patients with distal gastric tumors were less likely to undergo TG (16.5% versus 25.4% P < 0.0001). Patients undergoing PG for the SRGC histological variant had better OS (HR = 0.68, CI=0.61-0.76; P < 0.0001) versus those who underwent TG. Similarly, NSRGC patients undergoing PG also had improved OS, but to a lesser extent (HR = 0.91, CI = 0.85-0.96; P= 0.002). Overall, PG for GAC was associated with improved OS compared to TG, although the OS benefit is more profound in the SRGC histological variant (P < 0.0001). CONCLUSIONS Our results show that TG is not associated with improved OS in patients who undergo gastrectomy for GAC, even when adjusted for tumor location. The survival differences are more pronounced in the SRGC histology variant. The worst survival is observed in patients with SRGC who undergo TG after adjusting for different covariates.
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Affiliation(s)
- Maitham A Moslim
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth Handorf
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sanjay S Reddy
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Stephanie H Greco
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
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Keogh CJ, Keohane D, Harty JA, Mulcahy D. Nontraumatic Tibial Polyethylene Insert Cone Fracture in Rotating-Platform Total Knee Arthroplasty. Arthroplast Today 2021; 8:283-288.e1. [PMID: 34095405 PMCID: PMC8167323 DOI: 10.1016/j.artd.2021.02.013] [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: 12/01/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/16/2022] Open
Abstract
We report a case of a fracture through the polyethylene (PE) insert cone in a rotating-platform (RP) primary total knee arthroplasty (TKA) implant. This is the first reported case of cone fracture with this particular implant. This case highlights a 65-year-old female presenting with a 4-month history of knee pain and symptoms of instability 10 years after primary RP TKA. At the time of revision surgery, the PE insert cone was found to be fractured 10 mm from the inferior surface of the PE liner. Analysis suggests that the cone fracture occurred by fatigue failure which caused loosening of the tibial tray. Clinicians should be aware that this is a potential cause of failure with an RP TKA in the setting of symptoms including instability and pain.
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Affiliation(s)
- Cillian J Keogh
- Department of Trauma & Orthopaedic Surgery, Cork University Hospital and South Infirmary Victoria University Hospital, Wilton, Cork, Ireland
| | - David Keohane
- Department of Trauma & Orthopaedic Surgery, Cork University Hospital and South Infirmary Victoria University Hospital, Wilton, Cork, Ireland
| | - James A Harty
- Department of Trauma & Orthopaedic Surgery, Cork University Hospital and South Infirmary Victoria University Hospital, Wilton, Cork, Ireland
| | - David Mulcahy
- Department of Orthopaedic Surgery, Bon Secours Hospital, College Road, Cork, Ireland
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12
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Hamilton DA, Ononuju U, Nowak C, Chen C, Darwiche H. Differences in Immediate Postoperative Outcomes Between Robotic-Assisted TKA and Conventional TKA. Arthroplast Today 2021; 8:57-62. [PMID: 33718557 PMCID: PMC7921755 DOI: 10.1016/j.artd.2021.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/05/2021] [Accepted: 01/31/2021] [Indexed: 12/05/2022] Open
Abstract
Background Robotic-assisted total knee arthroplasty (TKA) is a growing technique in adult reconstruction. The variations between robotic-assisted and conventional TKA could lead to changes in immediate postoperative outcomes. We aimed to evaluate for differences in postoperative pain, discharge day, as well as post-hospital disposition (home vs subacute rehabilitation facility [SAR]) between robotic-assisted and conventional TKA. Methods We retrospectively identified 2 cohorts of patients who underwent either conventional or robotic-assisted TKA between January 2019 and July 2019. Their average pain scores from postoperative day 0, day 1, and day 2 were recorded. Their postoperative discharge day was recorded, as well as their disposition to either home or a SAR. Preoperatively, all patients are offered robotic-assisted TKA, and only those who want the procedure and undergo a preoperative CT scan receive the robotic-assisted surgery. Statistical analysis was conducted using SPSS. Results One hundred sixty-six patients were identified with 83 in each cohort. No differences between age, race, and gender were found. Despite minor variations in pain levels, the overall postoperative pain score analysis did not strongly favor one technique over the other. The robotic-assisted group had a significantly higher amount of patients discharged to home instead of a SAR and also had a shorter time to discharge than the conventional group. Conclusions Robotic-assisted TKA has similar postoperative pain scores compared with conventional TKA. The robotic-assisted cohort demonstrated other benefits including earlier discharge and are more likely to be discharged home instead of a SAR.
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Affiliation(s)
- David Alex Hamilton
- Detroit Medical Center Department of Orthopaedic Surgery, Detroit, MI, USA
- Corresponding author. Detroit Medical Center Department of Orthopaedic Surgery, 3990 John R Street - Harper 7 Brush, Detroit, MI 48021, USA. Tel.: +1 734 925 0880.
| | - Ucheze Ononuju
- Detroit Medical Center Department of Orthopaedic Surgery, Detroit, MI, USA
| | - Caden Nowak
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Chaoyang Chen
- Detroit Medical Center Department of Orthopaedic Surgery, Detroit, MI, USA
| | - Hussein Darwiche
- Detroit Medical Center Department of Orthopaedic Surgery, Detroit, MI, USA
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Williams BA, Ibinson JW, Ritter ME, Ezaru CS, Rakesh HR, Paiste HJ, Gilbert KL, Mikolic JM, Muluk VS, Piva SR. Extended Perineural Analgesia After Hip and Knee Replacement When Buprenorphine-Clonidine-Dexamethasone Is Added to Bupivacaine: Preliminary Report from a Randomized Clinical Trial. Pain Med 2020; 21:2893-2902. [PMID: 33027531 DOI: 10.1093/pm/pnaa229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We tested the hypothesis that buprenorphine-clonidine-dexamethasone (BCD) extends perineural analgesia compared with plain bupivacaine (BPV) nerve blocks used for hip and knee replacement surgery. DESIGN Prospective, parallel-arms, randomized, double-blind trial. SETTING A single veterans' hospital. SUBJECTS Seventy-eight veterans scheduled for total hip or knee replacement with plans for spinal as the primary anesthetic. METHODS Participants underwent nerve/plexus blocks at L2-L4 and L4-S3 in advance of hip or knee joint replacement surgery. Patients were randomized to receive BPV-BCD or plain BPV in a 4:1 allocation ratio. Patients answered four block duration questions (listed below). Time differences between treatments were analyzed using the t test. RESULTS Significant (P < 0.001) prolongation of the time parameters was reported by patients after the BPV-BCD blocks (N = 62) vs plain BPV (N = 16). The time until start of postoperative pain was 26 vs 11 hours (mean difference = 15 hours, 95% CI = 8 to 21). The time until no pain relief from the blocks was 32 vs 15 hours (mean difference = 17 hours, 95% CI = 10 to 24). The time until the numbness wore off was 37 vs 21 hours (mean difference = 16 hours, 95% CI = 8 to 23). The time until the worst postoperative pain was 39 vs 20 hours (mean difference = 19 hours, 95% CI = 11 to 27). CONCLUSIONS BPV-BCD provided 26-39 hours of perineural analgesia in the L2-L4 and L4-S3 nerve distributions after hip/knee replacement surgery, compared with 11-21 hours for plain BPV.
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Affiliation(s)
- Brian A Williams
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - James W Ibinson
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Marsha E Ritter
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Catalin S Ezaru
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Hulimangala R Rakesh
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Henry J Paiste
- Foundation for Anesthesia Education and Research (FAER), Schaumburg, Illinois.,University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen L Gilbert
- Veterans Research Foundation of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph M Mikolic
- StatCore, Veterans Research Foundation of Pittsburgh, Pittsburgh, Pennsylvania
| | - Visala S Muluk
- Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,IMPACT Clinic, Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Sara R Piva
- Physical Therapy-Clinical Translational Research Center, Pittsburgh, Pennsylvania.,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Agarwala S, Bhadiyadra R, Menon A. Analgesic effectiveness of Local Infiltrative Analgesia alone versus combined single dose adductor canal block with Local Infiltrative Analgesia: A single centre case control study. J Clin Orthop Trauma 2020; 11:S717-S721. [PMID: 32999545 PMCID: PMC7503062 DOI: 10.1016/j.jcot.2020.05.044] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Both adductor canal block (ACB) and of Local Infiltrative Analgesia (LIA) have been shown to reduce pain after total knee arthroplasty (TKA). The efficacy of combining ACB and LIA remains controversial. The objective of this study is to analyse the effect of LIA + single dose ACB compared to LIA alone on early post-operative pain and mobilization in TKA. METHODS This Cohort Prospective study analyses the Visual Analogue Score (VAS) pain scores and rehabilitation milestones at 24 h between LIA alone and LIA + single dose ACB in unilateral TKA operated by a single surgeon between August 2014 and February 2019. RESULTS VAS at rest and on movement were significantly better in the combined LIA + ACB group (n = 151) compared to LIA (n = 120) alone at 24 h. All patients were able to achieve the desired milestones of sitting, standing by the bedside and walking with the help of a walker within 24 h of the surgery. CONCLUSION Though the VAS scores were statistically significant, the actual scores at rest and on movement in both groups were significantly better than preoperative scores with excellent pain relief. All patients in both groups were able to ambulate within 24 h. LIA alone significantly improved the pain scores and enabled early mobilization. Addition of single dose ACB to LIA did not significantly alter the milestones.
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Affiliation(s)
- Sanjay Agarwala
- P D Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, 400016, Maharashtra, India,Corresponding author. P D Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, 400016, Maharashtra, India.
| | - Ravi Bhadiyadra
- Department of Orthopedics, P D Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, 400016, India
| | - Aditya Menon
- Department of Orthopedics, P D Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, 400016, India,Corresponding author.,
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15
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Redant S, De Bels D, Barbance O, Loulidi G, Honoré PM. Extracorporeal CO2 Removal Integrated within a Continuous Renal Replacement Circuit Offers Multiple Advantages. Blood Purif 2020; 50:9-16. [PMID: 32585671 DOI: 10.1159/000507875] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/13/2020] [Indexed: 11/19/2022]
Abstract
Extracorporeal CO2 removal within a continuous renal replacement therapy circuit offers multiple advantages for the regulation of the CO2 extraction. The authors review the impact of the dialysate solution, the buffer, and the anticoagulation on CO2 removal. They propose a theoretical model of the ideal circuit for the optimization of CO2 extraction.
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Affiliation(s)
- Sébastien Redant
- ICU Department, Brugmann University Hospital, Brussels, Belgium,
| | - David De Bels
- ICU Department, Brugmann University Hospital, Brussels, Belgium
| | - Oceane Barbance
- ICU Department, Brugmann University Hospital, Brussels, Belgium
| | - Ghalil Loulidi
- ICU Department, Brugmann University Hospital, Brussels, Belgium
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16
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Clement ND, Bell A, Simpson P, Macpherson G, Patton JT, Hamilton DF. Robotic-assisted unicompartmental knee arthroplasty has a greater early functional outcome when compared to manual total knee arthroplasty for isolated medial compartment arthritis. Bone Joint Res 2020; 9:15-22. [PMID: 32435451 PMCID: PMC7229306 DOI: 10.1302/2046-3758.91.bjr-2019-0147.r1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aims The primary aim of the study was to compare the knee-specific functional outcome of robotic unicompartmental knee arthroplasty (rUKA) with manual total knee arthroplasty (mTKA) for the management of isolated medial compartment osteoarthritis. Secondary aims were to compare length of hospital stay, general health improvement, and satisfaction between rUKA and mTKA. Methods A powered (1:3 ratio) cohort study was performed. A total of 30 patients undergoing rUKA were propensity score matched to 90 patients undergoing mTKA for isolated medial compartment arthritis. Patients were matched for age, sex, body mass index (BMI), and preoperative function. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were collected preoperatively and six months postoperatively. The Forgotten Joint Score (FJS) and patient satisfaction were collected six months postoperatively. Length of hospital stay was also recorded. Results There were no significant differences in the preoperative demographics (p ⩾ 0.150) or function (p ⩾ 0.230) between the groups. The six-month OKS was significantly greater in the rUKA group when compared with the mTKA group (difference 7.7, p < 0.001). There was also a greater six-month postoperative EQ-5D (difference 0.148, p = 0.002) and FJS (difference 24.2, p < 0.001) for the rUKA when compared to the mTKA. No patient was dissatisfied in the rUKA group and five (6%) were dissatisfied in the mTKA, but this was not significant (p = 0.210). Length of stay was significantly (p < 0.001) shorter in the rUKA group (median two days, interquartile range (IQR) 1 to 3) compared to the mTKA (median four days, IQR 3 to 5). Conclusion Patients with isolated medial compartment arthritis had a greater knee-specific functional outcome and generic health with a shorter length of hospital stay after rUKA when compared to mTKA. Cite this article: Bone Joint Res 2019;9(1):15–22.
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Affiliation(s)
- N D Clement
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Bell
- Spire Murrayfield Hospital, Edinburgh, UK
| | - P Simpson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK. Spire Murrayfield Hospital, Edinburgh, UK
| | - G Macpherson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK. Spire Murrayfield Hospital, Edinburgh, UK
| | - J T Patton
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK. Spire Murrayfield Hospital, Edinburgh, UK
| | - D F Hamilton
- Department of Orthopaedics, University of Edinburgh, University of Edinburgh, Edinburgh, UK
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17
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Balci M, Tuncel A, Aslan Y, Aykanat C, Berker D, Guzel O. Laparoscopic Partial versus Total Adrenalectomy in Nonhereditary Unilateral Adrenal Masses. Urol Int 2019; 104:75-80. [PMID: 31242477 DOI: 10.1159/000501216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/22/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the surgical outcomes and clinical improvement 1 year after laparoscopic partial and total adrenalectomy for the treatment of patients with nonhereditary unilateral functional adrenal adenomas. MATERIAL AND METHODS From March 2016 to January 2018, we performed 15 laparoscopic partial adrenalectomy (LPA; Group 1) and 25 laparoscopic total adrenalectomy (LTA; Group 2) procedures. The key points reside in adenoma identification, preservation of the remaining glandular parenchyma, and its blood supply with dissection in the space between the adenoma and the normal parenchyma. The operative and clinical outcomes were compered. RESULTS The mean age of the patients was 45.1 (17-69) years and the median follow-up was 15 (12-26) months. Operative time, blood loss, and hospital stay were similar between the groups. No major perioperative and postoperative complications occurred. After surgery, all patients had resolution of their symptoms, with no patient in Group 1 requiring steroid replacement. However, a patient in Group 2 required steroid replacement therapy. On postoperative imaging, no residual and recurrent mass was detected. CONCLUSIONS Our results showed that LPA is safe and feasible, and has similar therapeutic results compared with LTA in patients with a nonhereditary hormonally active unilateral adrenal mass. Furthermore, LPA can obviate the need for steroid replacement in these patients.
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Affiliation(s)
- Melih Balci
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey,
| | - Altug Tuncel
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Yilmaz Aslan
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Can Aykanat
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Dilek Berker
- Department of Endocrinology and Metabolism Diseases, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Ozer Guzel
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
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Bello S, Afolabi RF, Ajayi DT, Sharma T, Owoeye DO, Oduyoye O, Jasanya J. Empirical evidence of delays in diagnosis and treatment of pulmonary tuberculosis: systematic review and meta-regression analysis. BMC Public Health 2019; 19:820. [PMID: 31238906 PMCID: PMC6593585 DOI: 10.1186/s12889-019-7026-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 05/08/2018] [Accepted: 05/22/2019] [Indexed: 12/29/2022] Open
Abstract
Background Delays in diagnosis and treatment of pulmonary tuberculosis are a major set-back to global tuberculosis control. There is currently no global evidence on the average delays thus, the most important contributor to total delay is unknown. We aimed to estimate average delay measures and to investigate sources for heterogeneity among studies assessing delay measures. Methods Systematic review of studies reporting mean (± standard deviation) or median (interquartile range, IQR) of patient, doctor, diagnostic, treatment, health system and/or total delays in journal articles indexed in PubMed. We pooled mean delays using random-effects inverse variance meta-analysis, investigated for variations in pooled estimates in subgroup analyses and explored for sources of heterogeneity using pre-specified explanatory variables. Results The systematic review included 198 studies (831,724 patients) from 78 countries. The median number of patients per study was 243 (IQR; 160–458) patients. Overall, the pooled mean total delay was 87.6 (95% CI: 81.4–93.9) days. The most important and largest contributor to total delay was patient delay with a pooled mean delay of 81 (95% CI: 70–92) days followed by doctor’s delay and treatment delay with pooled mean delays of 29.5 (95% CI: 25.9–33.0) and 7.9 (95% CI: 6.9–8.9) days respectively. There was considerable heterogeneity in all pooled analyses (I2 > 95%). In the meta-regression models of mean delays, studies excluding extra-pulmonary tuberculosis patients reported increased mean doctor’s delay by 45 days on average, non-use of chest x-ray and conducting studies in high income countries decreased mean treatment delay by 20 and 22 days on average, respectively. Conclusion Strategies to address patients’ delay could have important implications for the success of the global tuberculosis control programmes.
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Affiliation(s)
- Segun Bello
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Rotimi Felix Afolabi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - David Taiwo Ajayi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tarang Sharma
- Cochrane, Editorial and Methods Department, Cochrane Central Executive, Cochrane Informatics and Knowledge Management Department Denmark ApS, c/o Rigshospitalet, afd. 7811, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Deborah Olamiposi Owoeye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Omobola Oduyoye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joseph Jasanya
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Haraldsson A, Engellau J, Lenhoff S, Engelholm S, Bäck S, Engström PE. Implementing safe and robust Total Marrow Irradiation using Helical Tomotherapy - A practical guide. Phys Med 2019; 60:162-167. [PMID: 31000078 DOI: 10.1016/j.ejmp.2019.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 11/21/2018] [Revised: 03/22/2019] [Accepted: 03/30/2019] [Indexed: 11/16/2022] Open
Abstract
Total Marrow Irradiation (TMI) with Helical Tomotherapy is a radiotherapy treatment technique that targets bone marrow and sanctuary sites prior to stem cell or bone marrow transplantation (SCT/BMT). TMI is a complex procedure that involves several critical steps that all need to be carefully addressed for a successful implementation, such as dose homogeneity in field junctions, choice of target margins, integrity of treatment and back-up planning. In this work we present our solution for a robust and reproducible workflow throughout the treatment chain and data for twenty-three patients treated to date. MATERIAL & METHODS Patients were immobilized in a whole body vacuum cushion and thermoplastic mask. CT-scanning and treatment were performed in two parts with field matching at the upper thigh. Target consisted of marrow containing bone and sanctuary sites. Lungs, kidneys, bowel, heart and liver were defined as organs at risk (OAR). A fast surface scanning system was used to position parts of the body not covered by the imaging system (MVCT) as well as to reduce treatment time. RESULTS All patients completed their treatment and could proceed with SCT/BMT. Doses to OARs were significantly reduced and target dose homogeneity was improved compared to TBI. Robustness tests performed on field matching and patient positioning support that the field junction technique is adequate. Replacing MVCT with optical surface scanning reduced the treatment time by 25 min per fraction. CONCLUSION The methodology presented here has shown to provide a safe, robust and reproducible treatment for Total Marrow Irradiation using Tomotherapy.
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Affiliation(s)
- André Haraldsson
- Medical Radiation Physics, Lund University, Lund, Sweden; Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
| | - Jacob Engellau
- Medical Radiation Physics, Lund University, Lund, Sweden; Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Stig Lenhoff
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Silke Engelholm
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sven Bäck
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Per E Engström
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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20
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García-García Á, Melián R, Carreras H, Rodríguez-Hernández V, Reñones J, Estévez B. Corneal dioptric power and astigmatism: A comparison between colour light-emitting diode based (Cassini TM) and Scheimpgflug technology (Pentacam TM) topography. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:273-280. [PMID: 30878244 DOI: 10.1016/j.oftal.2018.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/24/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022]
Abstract
AIM To determine the agreement and to compare the measurements obtained from a colour light-emitting diode based (CassiniTM) and Scheimpflug (PentacamTM) based topography in the evaluation of the anterior, posterior, and total corneal power and astigmatism. METHODS A total of 30 eyes from 30 healthy patients were consecutively measured using PentacamTM and CassiniTM. The main evaluated parameters were the anterior, posterior, and total dioptric power, and a power vector analysis of the astigmatism. The agreement between both devices was analysed using the intraclass correlation coefficient (ICC) and performing Bland-Altman plots. The comparison of means was performed using paired Student t-test. RESULTS The agreement between both devices when comparing the anterior and total corneal dioptric power was very high (ICC>0.85), but not when studying the posterior cornea (ICC<0.5). In the astigmatism analysis, measurements from the anterior cornea also showed an excellent agreement (ICC>0.78), but was poor for the corneal posterior surface (ICC<0.31). When studying the corneal dioptric power, no statistically significant differences were found for the anterior surface (P>.05), but PentacamTM obtained higher values for posterior and total surfaces (P<.001). As regards the magnitude of the astigmatism, no significant differences were found between both devices. CONCLUSION Both devices were highly comparable when studying the anterior cornea, but the agreement was poor-moderate when measuring posterior cornea. Therefore, the data obtained by both topographers are not interchangeable.
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Affiliation(s)
- Á García-García
- Clínica Eurocanarias Ofalmológica, Las Palmas de Gran Canaria, Las Palmas, España.
| | - R Melián
- Clínica Eurocanarias Ofalmológica, Las Palmas de Gran Canaria, Las Palmas, España
| | - H Carreras
- Clínica Eurocanarias Ofalmológica, Las Palmas de Gran Canaria, Las Palmas, España
| | | | - J Reñones
- Clínica Eurocanarias Ofalmológica, Las Palmas de Gran Canaria, Las Palmas, España
| | - B Estévez
- Clínica Eurocanarias Ofalmológica, Las Palmas de Gran Canaria, Las Palmas, España
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Sobh AH, Brown L, Moore DD. Intramuscular hemangioma after total hip arthroplasty: an iatrogenic etiology. Arthroplast Today 2018; 4:417-420. [PMID: 30569006 PMCID: PMC6287963 DOI: 10.1016/j.artd.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/26/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 11/01/2022] Open
Abstract
Soft-tissue hemangioma is a common benign tumor that can develop cutaneously, subcutaneously, or intramuscularly. Hemangioma formation within a muscular compartment is most often developmental in etiology; however, some cases are known to occur after blunt trauma to the soft tissues. To our knowledge, no cases of hemangioma formation after joint arthroplasty have been reported. We present a case of intramuscular hemangioma development within the hip abductor musculature after total hip arthroplasty via an anterolateral approach. Aside from developing congenitally or posttraumatically, hemangiomas may form after surgical dissection and must be considered as a source of anomalous swelling after surgery.
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Affiliation(s)
- Ali H. Sobh
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, MI, USA
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22
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Fernandez-Perez SA, Rodriguez JA, Beaton-Comulada D, Colon-Miranda RG, Soler-Salas AH, Otero-Lopez A. Total knee arthroplasty in patients with multiple hereditary exostoses. Arthroplast Today 2018; 4:325-329. [PMID: 30186915 PMCID: PMC6123178 DOI: 10.1016/j.artd.2017.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/26/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 11/17/2022] Open
Abstract
We present a case report of a patient with severe valgus deformity of the right knee due to multiple hereditary exostoses (MHEs) treated with total knee arthroplasty (TKA). The surgical management of MHE affecting the knee encompasses exostoses resection, joint deformity rectification, and limb-length discrepancy alignment. On rare occasions, distraction osteogenesis and TKA have been used to correct valgus deformities of the knee. TKA in MHE patients with knee involvement has only been described in 6 cases. Several considerations, such as extensive knowledge of frequently occurring skeletal aberrations, are required to successfully correct the deformities associated with MHE via TKA. This report describes a case of severe valgus knee deformity with a rotational component in MHE managed with TKA, the surgical technique, and future recommendations.
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Affiliation(s)
- Samuel A Fernandez-Perez
- Department of Orthopaedic Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Julio A Rodriguez
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
| | - David Beaton-Comulada
- Department of Orthopaedic Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Roberto G Colon-Miranda
- Department of Orthopaedic Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Antonio H Soler-Salas
- Department of Orthopaedic Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Antonio Otero-Lopez
- Department of Orthopaedic Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Tambalis KD, Panagiotakos DB, Psarra G, Sidossis LS. Current data in Greek children indicate decreasing trends of obesity in the transition from childhood to adolescence; results from the National Action for Children's Health (EYZHN) program. J Prev Med Hyg 2018; 59:E36-E47. [PMID: 29938238 DOI: 10.15167/2421-4248/jpmh2018.59.1.797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 01/29/2018] [Indexed: 12/28/2022]
Abstract
Introduction The aim of the study is to present the most recent estimates of obesity (total and central) prevalence in Greek children and associated risk factors. Methods Population data are derived from a yearly, school-based health survey polled in 2015 on 336,014 (51% boys) children aged 4 to 17 years old from almost 40% of all schools of primary and secondary education in Greece. Anthropometric and physical fitness measurements were obtained by trained investigators. Dietary habits, physical activity status, sedentary activities and sleeping hours were assessed through self-completed questionnaires. The gender and age-specific Body Mass Index (BMI) cut-off points were used in order to define BMI groups. Results The prevalence of overweight and obesity in the whole population was 22.2% and 9.0% in boys and 21.6% and 7.5% in girls, respectively. Obesity presented decreasing trends in the transition from childhood to adolescence. Central obesity was diagnosed in 95.3% and 93.5% of the simple obese boys and girls, respectively, in almost two to three of overweight children (68.6% of boys and 64.3% of girls), and in 12% of normal weight children. Age, physical fitness, low adherence to Mediterranean diet, insufficient sleeping hours, inadequate physical activity levels and increased screen time were all associated with higher odds of total and central obesity. Conclusions Serious and urgent actions need to be taken from public health policy makers in order not only to prevent a further increase in obesity rates but, more important, to treat obesity and/or the obesity associated co-morbidities.
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Affiliation(s)
- K D Tambalis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - D B Panagiotakos
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - G Psarra
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - L S Sidossis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
- Department of Kinesiology and Health, Rutgers University, New Brunswick, USA
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Grier AJ, Bala A, Penrose CT, Seyler TM, Bolognesi MP, Garrigues GE. Analysis of complication rates following perioperative transfusion in shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1203-1209. [PMID: 28153684 DOI: 10.1016/j.jse.2016.11.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 07/23/2016] [Revised: 11/21/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Postoperative anemia requiring a blood transfusion is not uncommon following anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). However, the potential complications in patients undergoing transfusion after shoulder arthroplasty remain unclear. The goal of this study was to examine the postoperative outcomes of patients receiving blood transfusions following TSA and RTSA. METHODS Using the Medicare Standard Analytic Files database, we identified all patients undergoing TSA or RTSA between 2005 and 2010. Using International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology codes, we identified the procedure, transfusion status, comorbidities, and postoperative complications of interest. Odds ratios and 95% confidence intervals were calculated. RESULTS We identified 7,794 patients who received a perioperative blood transfusion following TSA or RTSA, as well as 34,293 age- and gender-matched controls, during the study period. Patients who received a perioperative transfusion had statistically significantly higher rates of myocardial infarction, pneumonia, systemic inflammatory response syndrome or sepsis, venous thromboembolic events, and cerebrovascular accidents at all time points in question. Patients who received a blood transfusion also showed an increased incidence of surgical complications, including periprosthetic infection and mechanical complications, up to 2 years postoperatively. CONCLUSION To our knowledge, this represents the largest study to examine the relationship between the need for perioperative blood transfusion and postoperative medical and surgical outcomes following TSA and RTSA. The results observed in this study highlight the importance of preoperative counseling and medical optimization prior to shoulder arthroplasty, particularly in patients with preoperative anemia or multiple medical comorbidities.
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Affiliation(s)
- A Jordan Grier
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Abiram Bala
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Colin T Penrose
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
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Abstract
Aseptic loosening of implants remains the most common reason for revision surgery for hip, knee, or ankle prostheses. Although a great scientific effort has been made to explain the underlying mechanisms it remains poorly understood, complex, and multifactorial. Many factors, including age, body weight, activity lesions, implant design, fixation methods, material proprieties, immunologic responses, and biomechanical adaptations to total ankle replacement all contribute to the development of periprosthetic osteolysis.
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Affiliation(s)
- Norman Espinosa
- Institute for Foot and Ankle Reconstruction Zurich, Kappelistrasse 7, Zurich 8002, Switzerland.
| | - Georg Klammer
- Institute for Foot and Ankle Reconstruction Zurich, Kappelistrasse 7, Zurich 8002, Switzerland
| | - Stephan H Wirth
- Department of Orthopaedics, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland
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Jones MD, Carpenter C, Mitchell SR, Whitehouse M, Mehendale S. Retrograde femoral nailing of periprosthetic fractures around total knee replacements. Injury 2016; 47:460-4. [PMID: 26582217 DOI: 10.1016/j.injury.2015.10.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 08/31/2015] [Accepted: 10/14/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The incidence of primary total knee replacement (TKR) is increasing with a resultant rise in those patients sustaining distal femoral periprosthetic fractures around TKRs. The management of these fractures pose a significant challenge. The compatibility of retrograde femoral intramedullary (IM) nails with femoral TKR components needs to be considered preoperatively when this complex pathology is addressed. The aim of this study was to update the literature and assess the compatibility of the most commonly used primary TKR prostheses and retrograde femoral IM nails using a Sawbone anatomical model. METHODS AND MATERIALS Eight of the most commonly used primary TKR prostheses and four of the most commonly used retrograde femoral IM nails were identified. The femoral components of the TKRs were implanted onto left sided femoral Sawbones using the manufacturer's guides and cutting blocks and positioned appropriately. The retrograde IM nails were inserted using the conventional entry point and a nail was deemed compatible if this was possible through the femoral prosthesis. Details of whether a posterior entry point was required to allow insertion, whether the femoral nail was scratched by the femoral TKR prosthesis on insertion and whether excess force was required to insert the retrograde femoral IM nail were recorded. RESULTS The Biomet AGC Cruciate Retaining (CR) and Posterior Stabilised (PS) TKR were the only prostheses that were compatible with all the nails used. The other TKR prostheses were not compatible because of the force required to gain entry, scratching of the retrograde femoral IM nail or because a posterior entry point was required to gain entry through the intercondylar notch. CONCLUSION The majority of standard sized retrograde femoral nails are technically feasible for insertion through most femoral TKR components but this study has found that they are not compatible due to excessive force required for insertion, damage to the nail during insertion or the risk of anterior cortex perforation. Further studies are required to update the compatibility table and cadaveric studies would confirm the findings and allow further mechanical testing.
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Affiliation(s)
- Mark D Jones
- Department of Trauma and Orthopaedics, Tunbridge Wells Hospital, Maidstone and Tunbridge Wells NHS Trust, Tonbridge Road, Pembury TN2 4QJ, UK.
| | - Charlotte Carpenter
- Department of Trauma and Orthopaedics, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HQ, UK
| | - Stephen R Mitchell
- Department of Trauma and Orthopaedics, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HQ, UK
| | - Michael Whitehouse
- Musculoskeletal Research Unit, Level 1 Learning and Research Building, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK
| | - Sanchit Mehendale
- Department of Trauma and Orthopaedics, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HQ, UK
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Lyall FC, Clamp PJ, Hajioff D. Smartphone speech-to-text applications for communication with profoundly deaf patients. J Laryngol Otol 2016; 130:104-6. [PMID: 26611260 DOI: 10.1017/S0022215115003151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Visual communication aids, such as handwriting or typing, are often used to communicate with deaf patients in the clinic. This study aimed to establish the feasibility of communicating through smartphone speech recognition software compared with writing or typing. METHOD Thirty doctors and medical students were timed writing, typing and dictating a standard set of six sentences appropriate for a post-operative consultation, and the results were assessed for accuracy and legibility. RESULTS The mean time for smartphone dictation (17.8 seconds, 95 per cent confidence interval = 17.0-18.7) was significantly faster than writing (59.2 seconds, 95 per cent confidence interval = 56.6-61.7) or typing (44 seconds, 95 per cent confidence interval = 41.0-47.1) (p < 0.001). Speech recognition was slightly less accurate, but accuracy increased with time spent dictating. CONCLUSION Smartphone dictation is a feasible alternative to typing and handwriting. Slow speech may improve accuracy. Early clinical experience has been promising.
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Lee H, Chung KS, Park MS, Na S, Kim YS. Relationship of delayed parenteral nutrition protocol with the clinical outcomes in a medical intensive care unit. Clin Nutr Res 2014; 3:33-8. [PMID: 24527418 PMCID: PMC3921293 DOI: 10.7762/cnr.2014.3.1.33] [Citation(s) in RCA: 3] [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: 12/06/2013] [Revised: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 01/15/2023] Open
Abstract
Although parenteral nutrition (PN) is an important treatment for patients who are unable to tolerate enteral nutrition (EN), recent international guidelines recommended that PN should be reserved and initiated only after 7 days in well-nourished patients. This retrospective study was conducted to analyze the effect on clinical outcomes of a PN protocol with PN starting 4 days after admission to the intensive care unit (ICU). Eighty-one patients who were admitted from January to March of 2012 were included in the pre-protocol group, and 74 patients who were admitted from April to June of 2012 were included in the post-protocol group. There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared. Significantly fewer patients in the post-protocol group were provided PN (58.1% vs. 81.3%, p = 0.002), which was initiated significantly later than in the pre-protocol group (2.7 ± 2.2 days vs. 1.9 ± 2.0 days, p = 0.046). Five patients (6.2%) in the pre-protocol group acquired central line-associated bloodstream infection (CLA-BSI) in the ICU, yet none of the patients in the post-protocol group developed CLA-BSI (p = 0.03). The duration of antibiotic therapy and ICU stay were significantly shorter in the post-protocol group than in the pre-protocol group. By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved. Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.
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Affiliation(s)
- Hosun Lee
- Department of Nutrition and Dietetics, Severance Hospital, Yonsei University Health System, Seoul 120-752, Korea
| | - Kyung Soo Chung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Moo Suk Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Sungwon Na
- Department of Pain and Anesthesiology, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Young Sam Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea
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Nassar Y, Boudou N, Carrie D. Radial approach and single wiring as first intentional strategies in chronic total occlusions of the left anterior descending coronary artery. J Saudi Heart Assoc 2013; 25:67-73. [PMID: 24174849 DOI: 10.1016/j.jsha.2013.02.003] [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] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/11/2013] [Accepted: 02/24/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the left anterior descending coronary artery (LAD) specifically is associated with improved long-term 5 years survival as compared to PCI failure. Simpler PCI techniques may be successful and safer than complex techniques which are perceived to have high failure rates and technical complexity. We aimed to describe the safety and effectiveness of first intentional single wiring and radial approach in the treatment of patients with a CTO of the native LAD coronary artery at Toulouse Rangueil university hospitals. PATIENTS AND METHODS The study was a single center prospective registry. All patients showed evidence of myocardial viability in LAD territory. The operators' initial strategy was to start by a radial access as a first choice whenever feasible; if not, a femoral access was chosen. The initial strategy for lesion crossing in either antegrade or retrograde approaches was single wiring by lesion crossing using one guidewire (GW) as a simple technique. RESULTS A total of 30 patients with 30 LAD CTO lesions (100%) were recorded. Mean age was 71.6 + 15 years, 77% were males and 23% were females. The access route was radial 66% of the time and femoral 54% of the time and with double access for contralateral injection in 40% of the patients. Sheaths and catheters sizes 6F were used in 53% of the patients, and 7F in 73% of the patients. Overall lesion success rate was 83% of lesions. Single wiring was the prevailing technique used in 97% of successful lesions (83% of total cases), while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% of our total study cases with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% of our cases with a GW success rate of 67%. Q-wave myocardial infarction (MI), stent thrombosis, stroke, emergency coronary artery bypass graft (CABG), major bleeding, radiation dermatitis, cardiac tamponade or clinical perforation requiring any hemostatic maneuvers did not occur. There was a post-procedural Troponin rise of 3x normal levels in 30% of patients, and contrast induced nephropathy in 7%. Intra-aortic balloon counterpulsation (IABCP) was used in 3% of patients and cardiac death occurred in 3% of patients. CONCLUSION Single wiring and radial access as initial strategies in PCI for LAD-CTO lesions in either approaches antegrade or retrograde are associated with a high procedural success rate and an acceptable incidences of adverse events.
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Abstract
BACKGROUND Total hip arthroplasty (THA) is one of the most successful surgical interventions devised in modern times. Attempts to change the current THA procedure with unproven innovations bring the risk of increased failure rates while trying to improve the benefit of the surgery. QUESTIONS/PURPOSES This manuscript examines the evolution of THA at the Rothman Institute illustrating the key elements that lead the success of this procedure at this institution. These key elements include femoral stem design, use of highly crossed-linked polyethylene and use of pain and rehabilitation protocols. We attempted to describe the long-term results regarding safety, effectiveness, and durability of specific THA implant designs used at this institution drawing on reported evidence in the literature. METHODS The authors performed a review of peer-reviewed articles related to the Rothman Institute's experience with THA. RESULTS Total hip arthroplasty is an efficient, safe, and durable procedure. It is a highly successful operation to restore function and improve pain. The survivorship of THA procedures at the Rothman Institute is higher than 99% at 10 years based on mechanical failure. The use of collarless, tapered wedge femoral stem, highly crossed-linked polyethylene, and improved pain rehabilitation protocols have contributed to this success. CONCLUSIONS There is a well-documented long-term survivorship after THA. Future innovation in THA should address new challenges with younger and more demanding patients, rather than change current methods that have a proven good survivorship. This innovation depends mainly upon improvements in the bearing surfaces and advances in pain control and rehabilitation.
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