Fusion rate of 89% after knee arthrodesis using an intramedullary nail: a mono-centric retrospective review of 48 cases

Abstract Purpose Knee arthrodesis is an established procedure for limb salvage in cases of recurrent infection, total knee arthroplasty soft tissue defect, poor bone stock or a deficient extensor mechanism. Surgical options include compression plate, external fixator and arthrodesis nail. Different types of nail exist: long fusion nail, short modular nail and bridging nail. This study presents the results on knee arthrodesis using different types of intramedullary nails. The aim is to assess if a specific type of nail has a better fusion rate, clinical outcome and lower complication rate. Methods A mono-centric retrospective study of 48 knees arthrodesis was performed between 2000 and 2018. 15 T2™ Arthrodesis Nail, 6 OsteoBridge® Knee Arthrodesis and 27 Wichita® fusion nail were used. The mean clinic and radiological follow-up was 9.8 ± 3.8 years (2.6–18 years). Results Fusion rate was 89.6%. Time to fusion was 6.9 months. Mean Parker score was 6.9/9 points. Visual Analogic Scale was 1.9. The Wichita® fusion nail showed better results in terms of fusion, time to fusion and clinical outcome measured by Parker score and VAS but without statistical significance. The early revision rate was 10.4% and 20.8% presented a late complication requiring a surgery, due to nonunion or infection. 93.3% of infection was cured. Two patients live with a fistula (4.2%) and 1 was amputated (2.1%). Conclusion Although burdened by a big complication rate, knee arthrodesis with an intramedullary nail provides satisfactory results and is a good alternative to above-knee-amputation. The Wichita® fusion nail shows a tendency to better results compared to the two other nails. Level of evidence Case series, level IV

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Is It Safe to Combine a Fundoplication to Sleeve Gastrectomy? Review of Literature

Medicina ◽

10.3390/medicina57040392 ◽

2021 ◽

Vol 57 (4) ◽

pp. 392

Author(s):

Sergio Carandina ◽

Viola Zulian ◽

Anamaria Nedelcu ◽

Marc Danan ◽

Ramon Vilallonga ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Postoperative Complication ◽

Complication Rate ◽

Case Series ◽

Retrospective Case ◽

Postoperative Complication Rate ◽

Number Of Patients ◽

Different Types ◽

Gastric Stenosis ◽

Content Review

Background and Objectives: The rising numbers of laparoscopic sleeve gastrectomy (LSG) procedures now being performed worldwide will likely be followed by an increasing number of patients experiencing gastro-esophageal reflux disease (GERD). The purpose of the current review was to analyze in terms of safety different techniques of fundoplication used to treat GERD associated with LSG. Methods: An online search was performed in PubMed/MEDLINE in December 2020 to identify articles reporting LSG and fundoplication. The following term combination was used: (sleeve, fundoplication), (sleeve, Nissen), (sleeve, Rossetti), (sleeve, Toupet) and (sleeve, Dor). The extracted information included details of the methods (e.g., retrospective case series), demographic characteristics (e.g., age, gender), clinical characteristics, number of patients, rate of conversion, and postoperative outcomes. Results: A total of 154 studies were identified and after an assessment of title according to our exclusion criteria, 116 articles were removed. Of the 38 studies analyzed for full content review, a total of seven primary studies (487 patients) were identified with all inclusion criteria. Analyzing the different types of fundoplication used, we have identified: 236 cases of Nissen-Sleeve, 220 cases with modified Rossetti fundoplication, 31 cases of Dor fundoplication, and no case of Toupet fundoplication. The overall postoperative complication rate was 9.4%, with the most common reported complication being gastric perforation, 15 cases—3.1%. The second most common complication was bleeding identified in nine cases (1.8%) followed by gastric stenosis in six cases (1.2%). The mortality was nil. Conclusions: Different types of fundoplication associated with LSG appear to be a safe surgical technique with an acceptable early postoperative complication rate. Any type of fundoplication associated with LSG to decrease GERD should be evaluated cautiously while prospective clinical randomized trials are needed.

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The effect of platelet-rich plasma on the fusion rate and clinical outcome of spinal fusion surgery: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0243204 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243204

Author(s):

Ying-feng Cai ◽

Tian-Zhao Tian ◽

Li-Ye Chen ◽

Bao-Xin Liu ◽

Jian-Peng Zhou ◽

...

Keyword(s):

Clinical Outcome ◽

Cohort Studies ◽

Spinal Fusion ◽

Complication Rate ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Clinical Results ◽

Fusion Rate ◽

Fusion Surgery ◽

Spinal Fusion Surgery

Background Platelet-rich plasma (PRP) is widely used in many orthopedic surgeries and spinal disease treatments; however, the effect of PRP on spinal fusion remains controversial. Questions/Purposes To assess the fusion rate and clinical results of PRP compared with non-PRP administration in the treatment of spinal fusion with regard to decreasing pain and improving healing and function. Patients and methods Studies comparing PRP to non-PRP treatment with respect to the fusion rate and clinical outcome in patients who underwent spinal fusion surgery were included. Result Three randomized controlled trials (RCTs) and 7 prospective cohort studies were identified. The spinal fusion rate was not significantly different between the groups in all RCTs or cohort studies at the final follow-up. In comparison, PRP significantly reduced pain after surgery as evaluated in the RCT analysis and the complication rate did not differ significantly between the two groups. Conclusion According to the available studies, PRP does not contribute to the union rate, relieve pain or increase the complication rate in spinal fusion surgery. As clinical heterogeneity exists in these studies, further large, well-designed RCTs that focus on the standard assessment of PRP are needed.

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Axial interbody arthrodesis of the L5–S1 segment: a systematic review of the literature

Journal of Neurosurgery Spine ◽

10.3171/2015.1.spine14900 ◽

2015 ◽

Vol 23 (3) ◽

pp. 314-319 ◽

Cited By ~ 14

Author(s):

Gregory D. Schroeder ◽

Christopher K. Kepler ◽

MD MBA ◽

Alexander R. Vaccaro

Keyword(s):

Systematic Review ◽

Conflict Of Interest ◽

Complication Rate ◽

Safety Profile ◽

Case Series ◽

Fusion Rate ◽

Complication Rates ◽

Review Of The Literature ◽

Retrospective Case ◽

Additional Surgery

OBJECT The object of this study was to determine the fusion rate and safety profile of an axial interbody arthrodesis of the L5–S1 motion segment. METHODS A systematic search of MEDLINE was conducted for literature published between January 1, 2000, and August 17, 2014. All peer-reviewed articles related to the fusion rate of L5–S1 and the safety profile of an axial interbody arthrodesis were evaluated. RESULTS Seventy-four articles were identified, but only 15 (13 case series and 2 retrospective cohort studies) met the study inclusion criteria. The overall pseudarthrosis rate at L5–S1 was 6.9%, and the rate of all other complications was 12.9%. A total of 14.4% of patients required additional surgery, and the infection rate was 5.4%. Deformity studies reported a significantly increased rate of complications (46.3%), and prospectively collected data demonstrated significantly higher complication (36.8%) and revision (22.6%) rates. Lastly, studies with a conflict of interest reported lower complication rates (12.4%). CONCLUSIONS A systematic review of the literature indicates that an axial interbody fusion performed at the lumbosacral junction is associated with a high fusion rate (93.15%) and an acceptable complication rate (12.90%). However, these results are based mainly on retrospective case series by authors with a conflict of interest. The limited prospective data available indicate that the actual fusion rate may be lower and the complication rate may be higher than currently reported.

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Criteria positive and criteria negative anaphylaxis, with a focus on undifferentiated somatoform idiopathic anaphylaxis: A review and case series

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.41.200076 ◽

2020 ◽

Vol 41 (6) ◽

pp. 436-441 ◽

Cited By ~ 1

Author(s):

Daniel A. Rosloff ◽

Kunal Patel ◽

Paul J. Feustel ◽

Jocelyn Celestin

Keyword(s):

Diagnostic Criteria ◽

Statistical Significance ◽

Case Series ◽

Poor Response ◽

Response To Treatment ◽

Fisher Exact Test ◽

Subjective Symptoms ◽

Significant Difference ◽

Physical Findings ◽

Idiopathic Anaphylaxis

Background: Undifferentiated somatoform (US) idiopathic anaphylaxis (IA) is considered a psychogenic disorder characterized by a lack of observable physical findings and poor response to treatment. Although failure to diagnose true anaphylaxis can have disastrous consequences, identification of US-IA is crucial to limit unnecessary expenses and use of health care resources. Objective: To better define the presentation and understand the potential relationship between US-IA and underlying psychiatric comorbidities. Methods: We retrospectively reviewed 110 visits by 107 patients to our institution for evaluation and management of anaphylaxis over a 1-year period. The patients were classified as having either criteria positive (CP) or criteria negative (CN) anaphylaxis based on whether they met Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium criteria for the clinical diagnosis of anaphylaxis. Patient characteristics, including objective and subjective signs and symptoms, and the presence of psychiatric diagnoses were collected and analyzed. Statistical significance was assessed by using the Fisher exact test. A literature review of US-IA and other psychogenic forms of anaphylaxis was performed. Results: Patients with CP anaphylaxis were more likely to present with hypotension, wheezing, urticaria, and vomiting than were patients with CN anaphylaxis. The patients with CN anaphylaxis were more likely to present with subjective symptoms of sensory throat tightness or swelling compared with patients with CP anaphylaxis. No significant difference was detected in the prevalence of psychiatric conditions between the two groups. Conclusion: Patients who met previously established diagnostic criteria for anaphylaxis were more likely to present with objective physical findings than those who did not meet criteria for true anaphylaxis. CN patients who presented for treatment of anaphylaxis were more likely to present with subjective symptoms. Formal diagnostic criteria should be used by clinicians when evaluating patients with suspected anaphylaxis.

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Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1728989 ◽

2021 ◽

Author(s):

Gopal Krishna ◽

Varun Aggarwal ◽

Ishwar Singh

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Clinical Outcome ◽

Road Traffic ◽

Statistical Significance ◽

Platelet Counts ◽

Coagulation Abnormalities ◽

The Mean ◽

D Dimer

Abstract Introduction Traumatic brain injury (TBI) affects the coagulation pathway in a distinct way than does extracranial trauma. The extent of coagulation abnormalities varies from bleeding diathesis to disseminated thrombosis. Design Prospective study. Methods The study included 50 patients of isolated TBI with cohorts of moderate (MHI) and severe head injury (SHI). Coagulopathy was graded according to the values of parameters in single laboratory. The incidence of coagulopathy according to the severity of TBI and correlation with disseminated intravascular coagulation (DIC) score, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen was observed. The comparison was also made between expired and discharged patients within each group. It also compared coagulation derailments with clinical presentation (Glasgow Coma Scale [GCS]) and outcome (Glasgow Outcome Scale [GOS]). Results Road traffic accident was the primary (72%) mode of injury. Fifty-two percent had MHI and rest had SHI. Eighty-four percent of cases were managed conservatively. The mean GCS was 12.23 and 5.75 in MHI and SHI, respectively. Sixty-two percent of MHI and 96% of the patients with SHI had coagulation abnormalities. On statistical analysis, DIC score (p < 0.001) strongly correlated with the severity of head injury and GOS. PT and APTT were also significantly associated with the severity of TBI. In patients with moderate TBI, D-dimer and platelet counts showed association with clinical outcome. Fibrinogen levels did not show any statistical significance. The mean platelet counts remained normal in both the groups of TBI. The mean GOS was 1.54 and 4.62 in SHI and MHI, respectively. Conclusion Coagulopathy is common in isolated TBI. The basic laboratory parameters are reliable predictors of coagulation abnormalities in TBI. Coagulopathy is directly associated with the severity of TBI, GCS, and poor outcome.

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Comparative outcome analysis of bleb needling of fibrotic blebs in the clinic versus the operating room: a retrospective case series

BMC Ophthalmology ◽

10.1186/s12886-021-01870-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Vikram Ponnusamy ◽

Van Nguyen ◽

Jella A. An

Keyword(s):

Success Rate ◽

Operating Room ◽

Complication Rate ◽

Primary Outcome ◽

Case Series ◽

Outcome Analysis ◽

Retrospective Case ◽

Xen Gel Stent ◽

Retrospective Case Series ◽

Ab Interno

Abstract Background To compare 6 month outcomes of bleb needling performed in the clinic vs. the operating room (OR) in adult glaucoma patients with failed bleb. Methods A retrospective case series of 47 eyes from 41 glaucoma patients who received needling with mitomycin C (MMC) of scarred bleb from prior bleb-forming procedures in clinic (32 eyes) vs. the OR (15 eyes), including trabeculectomy (14 eyes), ExPress shunt (16 eyes), and ab-interno XEN gel stent (17 eyes). The primary outcome was needling success, defined as IOP ≤ 18 mmHg on 0 glaucoma medications without requiring an additional IOP lowering procedure within 6 months after needling. Results At 6 months, bleb needling success rate was similar when performed in the clinic vs. in the OR (28% vs. 20%, P = 0.54). Success rate was not statistically different in patients with prior trabeculectomy, ExPress shunt, and XEN gel stent (29% vs. 38% vs. 12%, P = 0.26). When comparing clinic vs. the OR needling procedures at 6 months, there was no difference in mean IOP (14.2 vs. 14.9 mmHg, P = 0.73), mean glaucoma medications (1.4 vs. 1.7, P = 0.69), additional IOP-lowering procedure rate (16% vs. 27%, P = 0.37), or complication rate (0% vs. 7%, P = 0.32). Conclusion Bleb needling with MMC in clinic may be a safe and effective way to revise failed bleb after trabeculectomy, ExPress shunt, and XEN gel stent procedures when compared to needling in the OR.

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The application of an allogeneic bone screw for osteosynthesis in hand and foot surgery: a case series

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03880-6 ◽

2021 ◽

Author(s):

Klaus Pastl ◽

Wolfgang Schimetta

Keyword(s):

Healing Process ◽

Case Series ◽

Clinical Importance ◽

Fusion Rate ◽

Surrounding Tissue ◽

Allogeneic Bone ◽

Foot Surgery ◽

Bone Screw ◽

Transplant Failure

Abstract Introduction The allogeneic bone screw transplant is a new osteosynthesis device making the use of foreign fixation material obsolete for various kinds of indications. Moreover, it is integrated into the recipient bone by natural bone remodeling without harming the surrounding tissue. The aim of this study was to determine the efficacy and safety of the transplant for osteotomy and arthrodesis in hand and foot surgery and to evaluate the clinical importance of the device. Materials and methods A single-surgeon case series of 32 patients who had undergone hand or foot surgery with the application of an allogeneic bone screw with an average follow-up time of 1 year is reported. Clinical data were reviewed to evaluate the pain levels and satisfaction of the patients and the frequency and type of complications occurring during the healing process. Routine radiography and computed tomography were reviewed to determine the fusion rate, the ingrowth behavior of the transplant and the possible occurrence of transplant failure. Results High patient satisfaction was paired with low postoperative pain levels and a low complication rate. 97% of the patients were free of pain at the timepoint of the second follow-up examination, the mean time of recovery of full mobility was 50.1 ± 26.1 days after surgery. Wound healing disturbance occurred only in two cases. Bony consolidation of the osteotomy or arthrodesis gap as well as osseointegration of the transplant was seen in all cases. No transplant failure or transplant loosening occurred. Conclusions The application of the allogeneic bone screw resulted in a 100% fusion rate while the patient burden was low. The transplant is safe and suited for various kinds of osteosynthesis in hand and foot surgery.

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The Risk of Acute Pancreatitis and Selective Serotonin Reuptake Inhibitors Use: A Meta-Analysis of Case–Control Studies

Dose-Response ◽

10.1177/1559325820902352 ◽

2020 ◽

Vol 18 (1) ◽

pp. 155932582090235

Author(s):

Shih-Wei Lai ◽

Cheng-Chan Yu ◽

Cheng-Li Lin ◽

Kuan-Fu Liao

Keyword(s):

Acute Pancreatitis ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Meta Analysis ◽

Statistical Significance ◽

Case Series ◽

Serotonin Reuptake Inhibitors ◽

Selective Serotonin ◽

Statistical Association ◽

Case Control Studies

Background/Objective: Some case series and case report have shown the association between the risk of acute pancreatitis and use of selective serotonin reuptake inhibitors. The results of systematic studies were not consistent. Methods: A meta-analysis was performed to investigate the risk of acute pancreatitis associated with use of selective serotonin reuptake inhibitors. Results: There was no statistical association between the risk of acute pancreatitis and selective serotonin reuptake inhibitors use (odds ratio: 1.19, 95% confidence interval: 0.93-1.51). Conclusions: Despite reaching no statistical significance, the possibility of the association between the risk of acute pancreatitis and selective serotonin reuptake inhibitors use cannot be totally excluded.

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POS0645 RITUXIMAB THERAPY IN THE INTERSTITIAL LUNG DISEASE OF RHEUMATOID ARTHRITIS: A SYSTEMATIC REVIEW

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4192 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 560.3-561

Author(s):

E. F. Vicente-Rabaneda ◽

J. De la Macorra ◽

J. P. Baldivieso ◽

F. Gutiérrez-Rodríguez ◽

A. García-Vadillo ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Interstitial Lung Disease ◽

Lung Function ◽

Adverse Events ◽

Lung Disease ◽

Statistical Significance ◽

Connective Tissue Diseases ◽

Case Series ◽

Original Research ◽

Case Control Studies

Background:Interstitial lung disease (ILD) is a severe manifestation of rheumatoid arthritis (RA), linked to increased mortality. There is still no consensus on the best therapeutic strategy as there aren’t yet randomized controlled trials.Objectives:To analyze the available scientific evidence on the efficacy and safety of rituximab (RTX) treatment of interstitial lung disease (ILD) associated with rheumatoid arthritis (RA).Methods:A systematic search was carried out in PubMed until April 2020 following the PRISMA recommendations. Studies were selected according to the following inclusion criteria: (1) original research, including case series, case/control studies, cohort studies, and clinical trials; (2) population with RA and associated ILD, either monographically or together with other connective tissue diseases (CTD), provided that individualized data on patients with RA were provided; (3) patients treated with RTX; (4) objective and quantifiable results on the evolution of ILD after treatment with available data of FVC, DLCO and/or HRCT.Results:Of the 64 papers identified, 9 articles were selected. The studies showed great heterogeneity in design, both in the sample selection criteria and in the objectives of the analysis. Most were observational, retrospective (n = 6) or prospective (n = 2) studies, with only one open prospective experimental study. Those focused on RA predominated, but 3 of them also included patients with other CTDs. The mean age of the patients in the different studies ranged between 52 and 70 years, predominantly women. 40-79% had a history of smoking and were mostly positive for rheumatoid factor (83-100%) and anti-CCP (82-100%). The most frequent radiological patterns were NSIP, UIP and undefined. The outcome measures were diverse: changes in respiratory function tests (LTF) and HRCT, incidence of pulmonary dysfunction, mortality rates, effect on glucocorticoid deprivation, delay in inclusion in the lung transplant list and/or serious adverse events. The initiation of RTX was motivated by pulmonary and/or joint pathology, in patients with failure to other synthetic or biological DMARDs. A total of 393 treatment cycles were collected in 114 patients, with a mean of 3.45 cycles per patient. The RTX regimen was 2 infusions of 1g 2 weeks apart in all patients, except for 1 who received the lymphoma-like regimen. With regard to the efficacy of the treatment with RTX, improvement and especially stabilization of HRCT and LFT predominated, with numerically greater improvement for DLCO than for FVC. There was also a favorable trend in the evolution of patients treated with RTX compared to controls, although it did not reach statistical significance, and a lower risk of deterioration of lung function in patients treated with RTX versus those who had received other DMARDs. The mortality rate found at 5 years was lower than that previously described for the disease and half for the patients treated with RTX compared to those treated with anti-TNF. The adverse events described in the studies did not show additional safety alerts to those already described for RTX.Conclusion:RTX seems to be postulated as a promising therapy for patients with ILD associated with RA, showing a stabilizing effect on the lung function, with an acceptable safety profile. However, further research of higher methodological quality prospective studies is needed to confirm these favorable preliminary results.Disclosure of Interests:None declared

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Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a multi-institutional comparative study

African Journal of Urology ◽

10.1186/s12301-020-00083-0 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Amr A. Faddan ◽

Mahmoud M. Shalaby ◽

Mohamed Gadelmoula ◽

Younis Alshamsi ◽

Daniar K. Osmonov ◽

...

Keyword(s):

Radical Prostatectomy ◽

Complication Rate ◽

Perioperative Complications ◽

Statistical Significance ◽

Operating Time ◽

Perioperative Outcomes ◽

Academic Institutions ◽

Robot Assisted ◽

Surgical Specimen ◽

Significant Difference

Abstract Background The standard surgical treatment of localized prostate cancer (PCa) has been rapidly changed along the last two decades from open to laparoscopic and finally robot-assisted techniques. Herein, we compare the three procedures for radical prostatectomy (RP), namely radical retropubic (RRP), laparoscopic (LRP), and robot-assisted laparoscopic (RALRP) regarding the perioperative clinical outcome and complication rate in four academic institutions. Methods A total of 394 patients underwent RP between January 2016 and December 2018 in four academic institutions; their records were reviewed. We recorded the patient age, BMI, PSA level, Gleason score and TNM stage, type of surgery, the pathological data from the surgical specimen, the perioperative complications, unplanned reoperating, and readmission rates within 3 months postoperatively. Statistical significance was set at (P < 0.05). All reported P values are two-sided. Results A total of 123 patients underwent RALRP, 220 patients underwent RRP, and 51 underwent LRP. There was no statistically significant difference between the three groups regarding age, BMI, prostatic volume, and preoperative PSA. However, there were statistically significant differences between them regarding the operating time (P < .0001), catheterization period (P < .001), hospital stay (P < .0001), and overall complications rate (P = .023). Conclusions The minimally invasive procedures (RALRP and LRP) are followed by a significantly lower complication rate. However, the patients’ factors and surgical experience likely impact perioperative outcomes and complications.

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