scholarly journals Dural tear repair surgery comparative analysis: a stitch in time saves nine

2021 ◽  
Author(s):  
Charles Taylor ◽  
Amad Khan ◽  
Emad Shenouda ◽  
Nicholas Brooke ◽  
Ali Nader-Sepahi
Keyword(s):  
Infection Rate ◽  
Primary Closure ◽  
Neurological Symptoms ◽  
Dural Tear ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Repair Method ◽  
Operative Outcomes ◽  
Significant Difference ◽  
Dural Tears

Abstract Purpose A dural tear is a common iatrogenic complication of spinal surgery associated with a several post-operative adverse events. Despite their common occurrence, guidelines on how best to repair the defect remain unclear. This study uses five post-operative outcomes to the compare repair methods used to treat 106 dural tears to determine which method is clinically favourable. Methods Data were retrospectively collected from Southampton General Hospital’s online databases. 106 tears were identified and grouped per repair method. MANOVA was used to compare the following five outcomes: Length of stay, numbers of further admissions or revision surgeries, length of additional admissions, post-operative infection rate and dural tear associated neurological symptoms. Sub-analysis was conducted on patient demographics, primary vs non-primary closure and type of patch. Minimal clinically important difference (MCID) was calculated via the Delphi procedure. Results Age had a significant impact on patient outcomes and BMI displayed positive correlation with three-fifth of the predefined outcome measures. No significant difference was observed between repair groups; however, primary closure ± a patch achieved an MCID percentage improvement with regards to length of original stay, rate of additional admissions/surgeries and post-operative infection rate. Artificial over autologous patches resulted in shorter hospital stays, fewer readmissions, infections and neurological symptoms. Conclusion This study reports primary closure ± dural patch as the most efficient repair method with regards to the five reported outcomes. This study provides limited evidence in favour of artificial over autologous patches and recommends that dural patches be used in conjunction with primary closure. Level of evidence I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Morphological Variations and Normal Parameters of the Cross-Sectional Anatomy of the Tibiofibular Syndesmotic

2021 ◽  
pp. 193864002110552
Author(s):  
Seyed Ali Hashemi ◽  
Soheil Nosrati ◽  
Zahra Shayan ◽  
Amir Reza Vosoughi
Keyword(s):  
Tibiofibular Syndesmosis ◽  
Normal Range ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Morphological Variations ◽  
Upper Limit ◽  
Significant Difference ◽  
P 16 ◽  
Axial Ct ◽  
The Cross

Background: The aim of this study was to determine morphological variations and normal parameters of the cross-sectional tibiofibular syndesmotic anatomy. Methods: Configurations of syndesmosis, anterior syndesmotic width (ASW), posterior syndesmotic width (PSW), and overlap distance, defined as the overlap of medial fibula with a drawn line from tip of anterior tubercle of incisura fibularis to the posterior tip, were measured on normal computed tomography (CT) scans of 110 cases. Results: Seventy seven male (70%) and 33 female (30%) (left: 50 and right: 60) were assessed. Mean age of the cases was 33 ± 13 (range: 15-80) years. Three different syndesmotic configurations were crescent (55.5%), rectangular (39.1 %), and semicircle (5.4 %). Overall, mean ASW, PSW, and overlap distance were 2.72, 3.98, and 1.02 mm, respectively. Upper limit of normal ASW in crescent, rectangular, and semicircle was 4.80, 4.85, and 3.89 mm, respectively. The maximum of PSW in crescent, rectangular, and semicircle was 6.25, 6.50, and 4.97 mm, respectively. There was not significant difference between syndesmotic configurations based on age (P = .69) and sex (P = .16). Conclusions: During interpreting axial CT scan to diagnose syndesmotic injuries, the normal range of parameters according to the different configurations of the tibiofibular syndesmosis should be carefully considered. Level of Evidence: Level 4

scholarly journals COMPARISON OF EPOC AND RECOVERY ENERGY EXPENDITURE BETWEEN HIIT AND CONTINUOUS AEROBIC EXERCISE TRAINING

2019 ◽  
Vol 25 (1) ◽  
pp. 20-23 ◽  
Author(s):  
Mateus Ahlert ◽  
Fernando Matzenbacher ◽  
José Carlos dos Santos Albarello ◽  
Gustavo Henrique Halmenschlager
Keyword(s):  
Oxygen Consumption ◽  
Energy Expenditure ◽  
Aerobic Exercise ◽  
Maximal Oxygen Consumption ◽  
Aerobic Exercise Training ◽  
Fat Percentage ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Significant Difference ◽  
High Intensity Interval

ABSTRACT Objectives: The objective of this study was to compare EPOC - excess post-exercise oxygen consumption and recovery energy expenditure between high intensity interval aerobic exercise (HIIT) and continuous aerobic exercise in adult amateur runners. Methods: The study included 10 runners, with a mean age of 35.7 ± 5.87 years, height 1.69 ± 0.11 m; body mass 74.13 ± 11.26 kg; fat percentage 19.31 ± 4.27% and maximal oxygen consumption (VO2max) of 3.50 ± 0.64 l/kg/min-1. The continuous aerobic exercise protocol consisted of 20 minutes of running with intensity of 70-75% HRmax. Two 20-second cycles of 8 sprints were performed for HIIT at the highest possible speed, with 10 seconds of rest and a 3-minute interval between cycles. The sample group performed the two protocols at least 48 hours and at most one week apart. EPOC was observed using ergospirometry after the running protocols, and mean consumption was analyzed between 25-30 minutes after exercise. Oxygen consumption at 9-10 minutes was used for resting consumption. The study has a cross-sectional experimental design. Results: Oxygen consumption of 0.57 ± 0.29l/kg/min1 and energy expenditure of 2.84 ± 1.44 kcal/min were observed for continuous aerobic exercise, with values of 0.61 ± 0.62 l/kg/min−1 and 3.06 ± 1.10 kcal/min respectively (p <0.05) for HIIT. Conclusion: The protocols performed did not show a statistically significant difference in terms of EPOC and energy expenditure, but the performance of HIIT increased lipid metabolism for exercise recovery, which may favor the weight loss process. Moreover, this activity model takes up less time. Level of evidence I, randomized clinical trial.

Hard, soft and off-the-shelf foot orthoses and their effect on the angle of the medial longitudinal arch: A biplane fluoroscopy study

2019 ◽  
Vol 43 (3) ◽  
pp. 331-338 ◽  
Author(s):  
Megan Balsdon ◽  
Colin Dombroski ◽  
Kristen Bushey ◽  
Thomas R Jenkyn
Keyword(s):  
Study Design ◽  
Foot Orthoses ◽  
Medial Longitudinal Arch ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Longitudinal Arch ◽  
Significant Difference ◽  
Skeletal Kinematics ◽  
Dynamic Gait ◽  
Foot Orthosis

Background: Foot orthoses have proven to be effective for conservative management of various pathologies. Pathologies of the lower limb can be caused by abnormal biomechanics such as irregular foot structure and alignment, leading to inadequate support. Objectives: To compare biomechanical effects of different foot orthoses on the medial longitudinal arch during dynamic gait using skeletal kinematics. Study design: This study follows a prospective, cross-sectional study design. Methods: The medial longitudinal arch angle was measured for 12 participants among three groups: pes planus, pes cavus and normal arch. Five conditions were compared: three orthotic devices (hard custom foot orthosis, soft custom foot orthosis and off-the-shelf Barefoot Science©), barefoot and shod. An innovative method, markerless fluoroscopic radiostereometric analysis, was used to measure the medial longitudinal arch angle. Results: Mean medial longitudinal arch angles for both custom foot orthosis conditions were significantly different from the barefoot and shod conditions ( p < 0.05). There was no significant difference between the off-the-shelf device and the barefoot or shod conditions ( p > 0.05). In addition, the differences between hard and soft custom foot orthoses were not statistically significant. All foot types showed a medial longitudinal arch angle decrease with both the hard and soft custom foot orthoses. Conclusion: These results suggest that custom foot orthoses can reduce motion of the medial longitudinal arch for a range of foot types during dynamic gait. Level of evidence: Therapeutic study, Level 2. Clinical relevance Custom foot orthoses support and alter the position of the foot during weightbearing. The goal is to eliminate compensation of the foot for a structural deformity or malalignment and redistribute abnormal plantar pressures. By optimizing the position of the foot, the medial longitudinal arch (MLA) will also change and quantifying this change is of interest to clinicians.

Surgical Site Infection Rate Drops to 0% Using a Vacuum-Assisted Closure in Contaminated/ Dirty Infected Laparotomy Wounds

2017 ◽  
Vol 83 (5) ◽  
pp. 512-514 ◽  
Author(s):  
Gerardo Lozano-Balderas ◽  
Alejandro Ruiz-Velasco-Santacruz ◽  
Jose Antonio Diaz-Elizondo ◽  
Juan Antonio Gomez-Navarro ◽  
Eduardo Flores-Villalba
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Primary Closure ◽  
Statistical Significance ◽  
Site Infection ◽  
Class Iii ◽  
Infection Rates ◽  
Vacuum Assisted Closure ◽  
Significant Difference ◽  
Delayed Closure

Wound site infections increase costs, hospital stay, morbidity, and mortality. Techniques used for wounds management after laparotomy are primary, delayed primary, and vacuum-assisted closures. The objective of this study is to compare infection rates between those techniques in contaminated and dirty/ infected wounds. Eighty-one laparotomized patients with Class III or IV surgical wounds were enrolled in a three-arm randomized prospective study. Patients were allocated to each group with the software Research Randomizer® (Urbaniak, G. C, & Plous, S., Version 4.0). Presence of infection was determined by a certified board physician according to Centers for Disease Control's Criteria for Defining a Surgical Site Infection. Twenty-seven patients received primary closure, 29 delayed primary closure, and 25 vacuum-assisted closure, with no exclusions for analysis. Surgical site infection was present in 10 (37%) patients treated with primary closure, 5 (17%) with primary delayed closure, and 0 (0%) patients receiving vacuum-assisted closure. Statistical significance was found between infection rates of the vacuum-assisted group and the other two groups. No significant difference was found between the primary and primary delayed closure groups. The infection rate in contaminated/dirty-infected laparotomy wounds decreases from 37 and 17 per cent with a primary and delayed primary closures, respectively, to 0 per cent with vacuum-assisted systems.

Measurement of Glenohumeral Internal Rotation in Asymptomatic Tennis Players and Swimmers

2009 ◽  
Vol 37 (5) ◽  
pp. 1017-1023 ◽  
Author(s):  
Renato Rangel Torres ◽  
João Luiz Ellera Gomes
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Control Group ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Tennis Players ◽  
Glenohumeral Internal Rotation Deficit ◽  
Significant Difference ◽  
Overhead Sports ◽  
The Difference

Background Glenohumeral internal rotation deficit, often diagnosed in players of overhead sports, has been associated with the development of secondary shoulder lesions. Hypothesis Asymptomatic players of different overhead sports will exhibit variable degrees of glenohumeral internal rotation deficit. Study Design Cross-sectional study; Level of evidence, 3. Methods Fifty-four asymptomatic male volunteers (108 shoulders) divided into 3 groups (tennis players, swimmers, control group) underwent measurements of glenohumeral internal and external rotation using clinical examination with scapular stabilization. Measurements of dominant and nondominant shoulders were compared within and between groups. Glenohumeral internal rotation deficit (GIRD) was defined as the difference in internal rotation between the nondominant and dominant shoulders. Results In tennis players, mean GIRD was 23.9° ± 8.4° (P < .001); in swimmers, 12° ± 6.8° (P < .001); and in the control group, 4.9° ± 7.4° (P = .035). Dominant shoulders showed significant difference between all groups, and the difference in internal rotation of the dominant shoulder between the group of tennis players in comparison with the control group (27.6°, P < .001) was greater than the difference in internal rotation of the dominant shoulder found in the group of swimmers compared with the control group (17.9°, P < .001). Between tennis players and swimmers, the difference in internal rotation of the dominant shoulder was 9.7° (P = .002). Conclusion Dominant limbs showed less glenohumeral internal rotation than the nondominant limbs in all groups, with the deficit in the group of tennis players about twice the deficit found for swimmers. Mean difference between limbs in the control group was less than 5°, which is within normal parameters according to most studies. There were statistically significant differences between all groups when dominant shoulders were compared with each other, differences that were not compensated by external rotation gain. Tennis players had the least range of motion, followed by swimmers.

Prevalence of Linguatula serrata infection in domestic ruminants from Meshkin Shahr, Iran

2018 ◽  
Vol 68 (2) ◽  
pp. 175 ◽  
Author(s):  
Β. ESMAEILNEJAD ◽  
J. GHAREKHANI ◽  
H. REZAEI ◽  
M. GOLABI ◽  
N. MOLAYI
Keyword(s):  
Infection Rate ◽  
Age Groups ◽  
Intermediate Hosts ◽  
Mesenteric Lymph Nodes ◽  
Endemic Region ◽  
Linguatula Serrata ◽  
Cross Sectional ◽  
Domestic Ruminants ◽  
Significant Difference ◽  
Northwest Of Iran

Linguatula serrata is an aberrant cosmopolitan parasite, which inhabits the canine respiratory system (final host). The domestic ruminants such as sheep, goats, cattle and buffaloes (intermediate hosts) play the important role for transmission of parasite to humans and animals. The current investigation aimed to investigate the prevalence of L. serrata infection in domestic ruminants in Meshkin Shahr, Northwest of Iran. In cross-sectional study between March 2013 and March 2014, the mesenteric lymph nodes (MLNs) of 753 sheep, 403 goats, 657 cattle, and 341 buffaloes were sampled in Meshkin Shahr slaughterhouse, randomly. All of samples were examined for L. serrata infection using parasitology methods. The prevalence rate was reported 26.30% in goats, 18.32% in sheep, 14.30% in cattle, and 13.19% in buffaloes (P<0.05). In all animals, a significant difference were found between infection rate and different seasons (P<0.05), opposite to different age groups. Also, there was significant differences between infection rate and gender in cattle (P=0.024, OR=1.6) and buffaloes (P=0.034, OR=2), unlike to sheep and goats (P>0.05). This study was demonstrated of linguatulosis in domestic ruminants from Northwest of Iran for first time. According to our findings, Meshkin Shahr is a new endemic region for L. serrata infection in Iran. Since the linguatulosis is a zoonotic parasitic disease, preventive measures to break the parasite’s life cycle and reduce the risk of infection in humans and animals is highly recommended.

Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation Techniques for Syndesmotic Injuries

2016 ◽  
Vol 37 (12) ◽  
pp. 1317-1325 ◽  
Author(s):  
Onur Kocadal ◽  
Mehmet Yucel ◽  
Murad Pepe ◽  
Ertugrul Aksahin ◽  
Cem Nuri Aktekin
Keyword(s):  
Screw Fixation ◽  
Ct Scans ◽  
Functional Evaluation ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Suture Button ◽  
Fixation Group ◽  
Significant Difference ◽  
The Mean

Background: Among the most important predictors of functional results of treatment of syndesmotic injuries is the accurate restoration of the syndesmotic space. The purpose of this study was to investigate the reduction performance of screw fixation and suture-button techniques using images obtained from computed tomography (CT) scans. Methods: Patients at or below 65 years who were treated with screw or suture-button fixation for syndesmotic injuries accompanying ankle fractures between January 2012 and March 2015 were retrospectively reviewed in our regional trauma unit. A total of 52 patients were included in the present study. Fixation was performed with syndesmotic screws in 26 patients and suture-button fixation in 26 patients. The patients were divided into 2 groups according to the fixation methods. Postoperative CT scans were used for radiologic evaluation. Four parameters (anteroposterior reduction, rotational reduction, the cross-sectional syndesmotic area, and the distal tibiofibular volumes) were taken into consideration for the radiologic assessment. Functional evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale at the final follow-up. The mean follow-up period was 16.7 ± 11.0 months, and the mean age was 44.1 ± 13.2. Results: There was a statistically significant decrease in the degree of fibular rotation ( P = .03) and an increase in the upper syndesmotic area ( P = .006) compared with the contralateral limb in the screw fixation group. In the suture-button fixation group, there was a statistically significant increase in the lower syndesmotic area ( P = .02) and distal tibiofibular volumes ( P = .04) compared with the contralateral limbs. The mean AOFAS scores were 88.4 ± 9.2 and 86.1 ± 14.0 in the suture-button fixation and screw fixation group, respectively. There was no statistically significant difference in the functional ankle joint scores between the groups. Conclusion: Although the functional outcomes were similar, the restoration of the fibular rotation in the treatment of syndesmotic injuries by screw fixation was troublesome and the volume of the distal tibiofibular space increased with the suture-button fixation technique. Level of Evidence: Level III, retrospective comparative study.

scholarly journals TOMOGRAPHIC MORPHOLOGICAL STUDY OF THE CRANIUM AND ITS CORRELATION WITH CRANIAL HALO USE IN ADULTS

2017 ◽  
Vol 25 (1) ◽  
pp. 11-14
Author(s):  
TIAGO FERREIRA DE ALMEIDA ◽  
HOMAR TOLEDO CHARAFEDDINE ◽  
FERNANDO FLORES DE ARAÚJO ◽  
ALEXANDRE FOGAÇA CRISTANTE ◽  
RAPHAEL MARTUS MARCON ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Morphological Study ◽  
Descriptive Analysis ◽  
Parietal Bone ◽  
Frontal Bone ◽  
Ct Scans ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Significant Difference ◽  
Parietal Bones

ABSTRACT Objective: To evaluate using tomographic study the thickness of the cranial board at the insertions points of the cranial halo pins in adults Methods: This is a retrospective, cross-sectional, descriptive analysis of Computed Tomography (CT) scans of adult patients' crania. The study included adults between 20 and 50 years without cranial abnormalities. We excluded any exam with cranial abnormalities Results: We analyzed 50 CT scans, including 27 men and 23 women, at the original insertion points and alternative points (1 and 2 cm above the frontal and parietal bones). The average values were 7.4333 mm in the frontal bone and 6.0290 mm in the parietal bone Conclusion: There was no statistically significant difference between the classical and alternative points, making room for alternative fixings and safer introduction of the pins, if necessary. Level of Evidence II, Retrospective Study.

scholarly journals Role of inflammation in non-allergic rhinitis

2014 ◽  
Vol 52 (2) ◽  
pp. 142-149
Author(s):  
E. de Corso ◽  
M. Battista ◽  
M. Pandolfini ◽  
L. Liberati ◽  
S. Baroni ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Symptoms ◽  
Diagnostic Algorithm ◽  
Inflammatory Cell Infiltrate ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Significant Difference ◽  
Nasal Cytology ◽  
Non Allergic Rhinitis

Objective: To investigate the role of inflammation in non-allergic rhinitis (NAR) patients in a large series to establish the prevalence of different NAR-subtypes, clinical features and the role of nasal cytology in the diagnostic algorithm. Methodology: Patients were selected out of 3650 individuals who spontaneously presented at our institution. We consecutively enrolled 519 NAR-patients in an analytical cross-sectional study between November 2007 and June 2013 (level of evidence: 3b). All patients underwent rhinological evaluation including symptoms questionnaire, endoscopy, CT scan, allergy tests and nasal cytology. Results: The inflammatory cell infiltrate affects the severity of symptoms differently, allowing for identification of different phenotypes of NAR. We distinguished two groups: “NAR without inflammation”(NAR-) and “NAR with inflammation”(NAR+), in addition to different NAR-subtypes with inflammation. A significant difference was observed in terms of clinical symptoms and association with comorbidities (previously diagnosed asthma and aspirin intolerance) between NAR–, NAR+ and between different NAR+ subtypes. Conclusion: Our data suggest that NAR- and NAR with neutrophils behave similarly, showing lower symptom score values and a lower risk of association with comorbidities compared to NAR with eosinophils and mast cells (singularly or mixed). In our belief it is very important to establish the presence and type of inflammation in non-allergic rhinitis patients and nasal cytology is a very useful test in correct differential diagnosis.

scholarly journals An Analysis of Sports Specialization in NCAA Division I Collegiate Athletics

2019 ◽  
Vol 7 (1) ◽  
pp. 232596711882117 ◽  
Author(s):  
Hasani W. Swindell ◽  
Melanie L. Marcille ◽  
David P. Trofa ◽  
Franklin E. Paulino ◽  
Natasha N. Desai ◽  
...  
Keyword(s):  
Ncaa Division I ◽  
Elite Athletes ◽  
Youth Sports ◽  
Team Sports ◽  
Division I ◽  
P Value ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Significant Difference ◽  
Individual Sports

Background: Youth sports specialization has become more prevalent despite consequences such as increased injury rates and burnout. Young athletes, coaches, and parents continue to have misconceptions about the necessity of sports specialization, giving athletes the encouragement to focus on a single sport at a younger age. Purpose: To characterize the motivations for specialization and determine when elite athletes in various individual and team sports made the decision to specialize. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A Likert-style survey was developed and distributed to athletes from two National Collegiate Athletic Association (NCAA) Division I institutions. The survey’s Flesch-Kincaid grade level was 6.3. Statistical analysis was performed via the Student t test, where a P value less than .05 was considered significant. Results: A total of 303 athletes with a mean ± SD age of 19.9 ± 1.52 years across 19 sports were surveyed; 94.7% of specialized athletes had previously played another organized sport prior to college, and 45% of athletes had played multiple sports up to age 16 years. The mean age of specialization was 14.9 years, with a significant difference between athletes competing in team (15.5 years) and individual (14.0 years) sports ( P = .008). Males in individual sports specialized earlier than those in team sports ( P ≤ .001). Nearly one-fifth (17.4%) of athletes reported specializing at age 12 years or earlier. Personal interest, skill level, time constraints, and potential scholarships were the most important reasons for specialization overall. For individual sports, the motivations for specialization were similar, but collegiate ( P < .001) or professional ( P < .001) ambitions were significantly larger contributing factors. Conclusion: Early sports specialization is uncommon among NCAA Division I athletes for most team sports, whereas individual sports tend to have athletes who specialize earlier and are more motivated by professional and collegiate goals. This study characterized the timing of specialization among elite athletes, providing a basis for understanding the motivations behind youth sports specialization. Physicians should be prepared to discuss the misconception that early sports specialization is necessary or common among most team-focused collegiate-level athletes. Knowing the motivations for sports specialization will guide clinicians in their discussions with youth athletes.

Sign in / Sign up

Export Citation Format

Share Document