MO784ABDOMINAL AORTIC CALCIFICATIONS AND ARTERIOVENOUS FISTULA CLINICAL OUTCOMES ON HAEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Amira Saii ◽  
Toumi Salma ◽  
Beya Fendri ◽  
Hanen Abid ◽  
Rania Lahouimel ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Arteriovenous Fistula ◽  
Clinical Outcomes ◽  
Vascular Calcification ◽  
Strong Relationship ◽  
Chronic Haemodialysis ◽  
Significant Difference ◽  
Spine Radiograph ◽  
The Mean ◽  
Lateral Lumbar Spine

Abstract Background and Aims Vascular calcification has now been recognized as a major problem in dialysis patients because of its strong influence on the prognosis of this population. Several reports have shown the strong relationship between vascular calcification and clinical outcomes including cardiovascular events and arteriovenous fistula (AVF)survival. The aim of this study is to evaluate the severity of vascular calcifications in our hemodialysis patients and to determine its impact on the AVF survival. Method It is a transversal descriptive and analytical study including chronic haemodialysis patients in our unit of the nephrology department. A lateral lumbar spine radiograph was taken: the aortic arch calcification(ACC) score (VCS) was calculated according to the score validated by Kauppila and Schousboe. The overall VCS ranged from 0 to 24. Results Our study included 55 patients divided into 31 men and 24 women with a sex ratio of 1.29. The mean age was 49.54 ± 12.66 years. The mean duration in HD was 96.16± 73 months. 76.8% of the patients have hypertension, 26.8% are diabetic and 14.3% are smokers. AVF failure was noted in 34 patients (60.7%). We divided our population in 3 groups: G1:23 patients with a low VCS (41.1%), G2: 15 patients with a moderate VCS (26.8%) and G3: 17 patients with a severe VCS (30.4%). Patients in G2 and G3 were more frequently diabetics (p=0.05): over 50% of patients in G3 were diabetic and the mean duration in HD was longer: 133 months in G3, 102 months in G2 and 74 months in G1 with a significant difference p=0.03. We noted that AVF failure was more frequent in patients in G2 and G3 (65.7%) patients) versus patients in G1 (39.13%) with a significant difference (p=0.01) Conclusion vascular access dysfunction is one of the leading causes of morbidity and mortality in haemodialysis patients We have demonstrated throw this study the relation between the presence of higher AAC grade and the poor survival of AVF in our patients. So, an identification of these ACC by a simple lateral lumbar spine radiograph would allow the clinician to implement more rigorous and planned monitoring for such AVFs.

scholarly journals Surgical Treatments for Lumbar Spine Diseases: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Kanthika Wasinpongwanich ◽  
Tanawin Nopsopon ◽  
Krit Pongpirul
Keyword(s):  
Lumbar Spine ◽  
Clinical Outcomes ◽  
Risk Ratio ◽  
Literature Search ◽  
Operative Time ◽  
Meta Analysis ◽  
Fusion Rate ◽  
Significant Difference ◽  
Spine Diseases

Purpose Surgical treatment is mandatory in some patients with lumbar spine diseases. To obtain spine fusion, many operative techniques were developed with different fusion rates and clinical results. This study aimed to collect randomized controlled trial (RCT) data to compare fusion rate, clinical outcomes, complications among Transforaminal Lumbar Interbody Fusion (TLIF), and other techniques for lumbar spine diseases. Methods A systematic literature search of PubMed, Embase, Scopus, Web of Science, and CENTRAL databases was searched for studies up to 13 February 2020. The meta-analysis was done using a random-effects model. Pooled risk ratio (RR) or mean difference (MD) with a 95% confidence interval of fusion rate, clinical outcomes, and complication in TLIF and other techniques for lumbar diseases. Results The literature search identified 3,682 potential studies, 15 RCTs (915 patients) were met our inclusion criteria and were included in the meta-analysis. Compared to other techniques, TLIF had slightly lower fusion rate (RR=0.84 [95% CI 0.72, 0.97], p=0.02, I2=0.0%) at 1-year follow-up while there was no difference on fusion rate at 2-year follow up (RR=1.06 [95% CI 0.96, 1.18], p=0.27, I2=69.0%). The estimated risk ratio of total adverse events (RR=0.90 [95% CI 0.59, 1.38], p=0.63, I2=0.0%) and revision rate (RR=0.78 [95%CI 0.34, 1.79], p=0.56, I2=39.0%) showed no difference. TLIF had approximately half an hour more operative time than other techniques (MD=31.88 [95% CI 5.33, 58.44], p=0.02, I2=92.0%). There was no significant difference between TLIF and other techniques in terms of the blood loss, and clinical outcomes. Conclusions Besides fusion rate at 1-year follow-up and operative time, our study demonstrated similar outcomes of TLIF with other techniques for lumbar diseases in regard to fusion rate, clinical outcomes, and complications.

Factors Affecting the Clinical Outcomes of Surgically Treated Ankle Fractures Associated with the Posterior Malleolar Fragment

2021 ◽  
Vol 111 (5) ◽  
Author(s):  
Mehmet Kuyumcu ◽  
Emre Bilgin ◽  
Hasan Bombacı
Keyword(s):  
Clinical Outcomes ◽  
Fragment Size ◽  
Statistical Significance ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
Ankle Osteoarthritis ◽  
Posterior Malleolus ◽  
Significant Difference ◽  
Functional Scores ◽  
The Mean

Background This study was performed to determine the factors that influence the clinical outcomes of surgically treated ankle fractures associated with the posterior malleolus (PM). Methods We evaluated 42 fractures of 42 patients. Posterior malleolus fracture size was calculated using computed tomography. Posterior malleolar fractures with a size less than 10% were left nonfixated. The decision for larger fragments was performed using fluoroscopy following the fixation of other components. If the joint was found to be congruent, the PM was left nonfixated. Otherwise, the PM was reduced and fixated. Clinical outcomes were evaluated based on Weber, Freiburg, and American Orthopaedic Foot and Ankle Society scores. Ankle osteoarthritis was determined according to the Canadian Orthopaedic Foot and Ankle Society classification. The effect of PM fixation, age, PM fragment size, waiting period before surgery, presence of ankle dislocation, and number of injured malleoli on clinical outcomes were assessed. Statistical significance was set at a value of P < .05. Results The mean patients age was 48.5 ± 14.9 years (range, 20–84 years) and the mean follow-up was 23.7 ± 8.6 months (range, 12–56 months). Fixation of the PM was performed solely in 12 patients. Postoperative displacement of the PM and articular step were less than 2 mm in all fractures. Statistically significant worse outcomes were demonstrated based on functional scores in the patients with a PM size greater than or equal to 25% (P = .042, P = .038, and P = .048, respectively) and in patients aged 60 years or older (P = .005, P = .007, and P = .018, respectively). However, there was no significant difference between functional scores and the other factors. Ankle osteoarthritis was observed at a higher rate in patients with PM size greater than or equal to 25% and in patients aged 60 years or older. Conclusions Clinical outcomes of the patients are mainly influenced by the patient's age and PM fragment size. However, if the tibiotalar joint is congruent, comparable results can be obtained in PM fixated or nonfixated patients.

scholarly journals Gap difference in navigated TKA: a measure of the imbalanced flexion-extension gap

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 30 ◽  
Author(s):  
Zi-Yang Chia ◽  
Hee-Nee Pang ◽  
Mann-Hong Tan ◽  
Seng-Jin Yeo
Keyword(s):  
Total Knee Arthroplasty ◽  
Social Functioning ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Computer Calculation ◽  
Bodily Pain ◽  
Significant Difference ◽  
Flexion Extension ◽  
Total Knee ◽  
The Mean

Introduction: The success of Total Knee Arthroplasty (TKA) hinges on balanced flexion-extension gaps. This paper aims to evaluate the correlation between imbalanced gaps and clinical outcomes, and hence help quantify the imbalanced gap in navigation-assisted total knee arthroplasty. Methods: We studied 195 knees with an average follow-up of two years. Flexion-extension gaps were obtained from computer calculation upon cementation of implants in both flexion (90°) and extension. The gap difference (GD) was defined as the measured difference between the gaps in flexion and extension. Results: At 2 years after surgery, the mean ROM in the balanced group, with GD less than or equal to 2 mm, was 115.1° ± 16.6° and the mean ROM in the imbalanced group was 116.7° ± 12.1°. This was not statistically significant with p-value 0.589. Balanced flexion-extension gaps also did not show significant difference in terms of mechanical alignment, with 0.29 ± 0.89 in the balanced group at 2 years, and 0.65 ± 1.51 in the imbalanced group with p-value 0.123. Balanced gaps however, were associated with improved outcomes in terms of physical functioning, bodily pain, social functioning, Oxford and Knee scores at 6 months and improved social functioning scores at 2 years. Conclusions: Computer navigation is a useful tool for assessing the gap balance in TKA. Balanced flexion-extension gaps, with gap differences of less than or equal to 2 mm, is associated with improved clinical outcomes at 6 months.

scholarly journals Clinical outcomes of arthroscopic repair of acetabular labral tears

2018 ◽  
Vol 4 (1) ◽  
pp. e000328 ◽  
Author(s):  
Carlos César Vassalo ◽  
Antônio Augusto Guimarães Barros ◽  
Lincoln Paiva Costa ◽  
Euler de Carvalho Guedes ◽  
Marco Antônio Percope de Andrade
Keyword(s):  
Clinical Outcomes ◽  
Arthroscopic Repair ◽  
Final Evaluation ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Senior Surgeon ◽  
Labral Tears ◽  
Significant Difference ◽  
The Mean

PurposeTo evaluate the primary clinical outcomes of arthroscopic labral repair.MethodsAll patients who underwent arthroscopic repair of the acetabular labrum performed by a senior surgeon between October 2010 and December 2013 were invited to participate in this prospective study. Patients included were those who had a preoperative diagnosis of labral tears, a lateral centre edge greater than 25° and a labral tear believed to be suturable during the intraoperative evaluation. Patients with Tönnis grade 2 or grade 3 hip osteoarthritis and those who had undergone a previous hip surgery were excluded. All patients were evaluated using the modified Harris Hip Score (mHHS) during the final appointment before surgery, 4 months after surgery and at the final evaluation. Interviews were conducted by the senior surgeon.ResultsEighty-four patients (90 hips) underwent arthroscopic repair. The mean age was 44.2 years and the mean follow-up period was 43.0 months (minimum of 25 months and maximum of 59 months). The mean mHHS was 80.4 preoperatively, 95.0 at 4 months postoperatively and 96.6 at final evaluation. A statistically significant difference existed among these scores (p<0.001).ConclusionArthroscopic labral repair was associated with a clinically significant improvement in mHHS after short-term (4 months) and medium-term (43 months) follow-up.Level of evidenceLevel IV, therapeutic case series.

scholarly journals Simultaneous Cervical and Lumbar Spine Surgery: Retrospective Analysis of 45 Cases

2019 ◽  
Vol 08 (01) ◽  
pp. 047-052 ◽  
Author(s):  
Amit Aiwale ◽  
Pankajkumar Patel ◽  
Syed Paspala ◽  
T. Murthy
Keyword(s):  
Lumbar Spine ◽  
Spinal Stenosis ◽  
Japanese Orthopaedic Association ◽  
Cost Effective ◽  
Lumbar Spine Surgery ◽  
Neurogenic Claudication ◽  
Cervical Canal ◽  
Canal Stenosis ◽  
Significant Difference ◽  
The Mean

Abstract Background The term ‘tandem spinal stenosis’ (TSS) was first introduced by Dagi et al to describe concurrent symptomatic cervical and lumbar spinal stenosis. A typical clinical picture includes intermittent neurogenic claudication, myelopathy, and polyradiculopathy in both the upper and lower extremities. The incidence of TSS ranges from 0.12 to 28%. Methods We studied patients who presented with tandem canal stenosis and operated cervicolumbar decompression with or without fusion procedures by two separate neurosurgical teams simultaneously from June 2015 to 2017 with follow-up period of minimum 6 months. Results We had 30 (66.66%) male and 15 (33.33%) female patients who underwent simultaneous cervical and lumbar spine surgeries. The average age was 57.8 years (male) and 53.9 years (female). Cervical canal stenosis was graded as per magnetic resonance imaging (MRI) morphological grades of stenosis by Kang et al and lumbar grading, was done as per Schizas et al grading system. The mean duration of complaints in cervical and lumbar compression was 29.54 ± 44.99 months and 30.55 ± 38.11 months, respectively. The mean preoperative Japanese Orthopaedic Association (JOA) score of was 10.46 ± 1.39, whereas the postoperative mean JOA score was 11.93 ± 1.28, and mean preoperative (38.59 ± 16.52) and postoperative (29.22 ± 9.38) Oswestry Disability Index (ODI) scores showed a statistically significant difference (p = 0.0001). Conclusion Patients with TSS are elderly and have associated comorbidities, still simultaneous cervical and lumbar surgery is feasible with the good outcome if you have two neurosurgical teams operating simultaneously and having good other super specialty teams’ support. It can be timesaving and cost effective for patients. Also, it avoids patients from undergoing exposure to two separate surgical and anesthetic stress.

scholarly journals Osteochondral allograft transplantation for large Hill-Sachs lesions: a retrospective case series with a minimum 2-year follow-up

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hongwu Zhuo ◽  
Yangkai Xu ◽  
Fugui Zhu ◽  
Ling Pan ◽  
Jian Li
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Satisfaction Rate ◽  
Allograft Transplantation ◽  
Constant Murley Score ◽  
Significant Difference ◽  
The Mean ◽  
Graft Resorption

Abstract Purpose To investigate the clinical outcomes after osteochondral allograft transplantation for large Hill-Sachs lesions. Methods Patients who underwent osteochondral allograft transplantation for large Hill-Sachs lesions were identified. Clinical assessment consisted of active range of motion (ROM), American Shoulder and Elbow Surgeons score (ASES), Constant-Murley score, Rowe score, and patient satisfaction rate. Radiographic assessment was performed with CT scan. Results Nineteen patients met the inclusion criteria. The mean age was 21.7 years. The mean preoperative size of the Hill-Sachs lesion was 35.70 ± 3.02%. The mean follow-up was 27.8 months. All grafts achieved union at an average of 3.47 months after surgery. At the final follow-up, graft resorption was observed in 43.1% of patients. The average size of residual humeral head articular arc loss was 12.31 ± 2.79%. Significant improvements (P < .001) were observed for the active ROM, ASES score, Constant-Murley score, and Rowe score. The overall satisfaction rate was 94.7%. No significant difference was found between the resorption group and the nonresorption group in postoperative clinical outcomes. Conclusion Osteochondral allograft transplantation is a useful treatment option for patients with large Hill-Sachs lesions. Although the incidence of graft resorption may be relatively high, the clinical outcomes at a minimum 2-year follow-up are favorable. Level of evidence Level IV, case series

Correlation of MECA-79-positive high endothelial venule density with clinical outcomes in upper tract urothelial carcinoma patients treated with radical nephroureterectomy.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 417-417
Author(s):  
Yasuhiro Hashimoto ◽  
Hayato Yamamoto ◽  
Tohru Yoneyama ◽  
Atsushi Imai ◽  
Shingo Hatakeyama ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Clinical Outcomes ◽  
Poor Prognosis ◽  
Disease Free Survival ◽  
Small Sample ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Upper Tract ◽  
Significant Difference ◽  
The Mean

417 Background: High endothelial venules (HEVs) are present in lymph nodes and tertiary lymphoid organs. It has been reported that low HEV density is associated with the poor prognosis of several carcinomas. MECA-79 antibody recognizes L-selectin ligand (6-sulfosialyl Lewis X glycan) expressed in HEV. In the present study, we examined whether MECA-79 positive HEV density was associated with clinical outcomes of patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Methods: Eighty-eight patients with UTUC who underwent RNU at the Hirosaki University hospital between January 2008 and December 2016 were enrolled. Tissue microarray for MECA-79 was performed, and HEV densities were calculated. HEV density < 1.5/mm2 was defined as HEV (−); HEV density ≥1.5/mm2 was defined as HEV(+). Results: Of 88 patients, 64 (72.7%) were male and 24 (27.2%) were female. The average age was 68.5 years (range, 36–84 years). Fifty-three patients (60.2%) had previously undergone neoadjuvant chemotherapy. The mean observation period was 39.0 months. Twenty-one (23.8%) patients developed recurrence, whereas 16 (33.3%) patients died during follow-up. Five-year cause-specific survival (CSS) rate was 66.1%, and five-year disease-free survival (DFS) rate was 70.7%. In our cohort, 25 (28.4%) patients were found to be HEV(−), whereas 63 (71.5%) were found to be HEV(+). The mean HEV density was 6.3/mm2(0-41.6). The 5-year DFS rates for HEV (+) and HEV (−) patients were 78.0% and 53.9%, respectively, with a statistically significant difference between the groups. (log-rank, p = 0.042). Moreover, the 5-year CSS rates for HEV (+) and HEV (−) patients were 72.5% and 53.4%, respectively, with a statistically significant difference between the groups. (log-rank, p = 0.0036). Conclusions: Low MECA-79-positive HEV density may be associated with poor prognosis of patients with UTUC treated with RNU. Despite the small sample size and preliminary nature of our study, our study provides valuable insights to guide future research.

scholarly journals Initial Clinical Outcomes of Percutaneous FullEndoscopic Lumbar Discectomy Using an Interlaminar Approach at the L4-L5

2017 ◽  
Vol 4 (20;4) ◽  
pp. E507-E512 ◽  
Author(s):  
Jun-ichiro Nakamura
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Disc Herniation ◽  
Operative Time ◽  
Small Sample ◽  
Lumbar Discectomy ◽  
Interlaminar Approach ◽  
Significant Difference ◽  
Endoscopic Discectomy ◽  
The Mean

Background: Percutaneous full-endoscopic discectomy (PED) is being increasingly used because of its potential to minimalize soft-tissue damage and decrease hospital stay. PED using the interlaminar approach (PED-IL) at L4-L5 is performed by only a few surgeons. To the best of our knowledge, the safety and efficacy of PED-IL at L4-L5, without experience in PED via a transforaminal approach (PED-TF) has not been previously reported. Objective: This study aimed to evaluate initial clinical outcomes and complications of PED-IL at L4-L5 without experience in PED-TF. Study Design: Retrospective evaluation. Setting: An urban minimally invasive spine hospital. Methods: Of a total of 50 patients (36 men and 14 women, ages ranging from 21-59 years, with the average age being 40.3 years old), 16 cases were performed at L4-L5 and 34 cases were performed at L5-S1. PED-IL was successfully completed in all cases, and no case required conversion to open surgery. The operative time, hospital stay, modified MacNab criteria, and visual analog scale (VAS) scores were examined at L5-S1 (range: 41-112). There was no significant difference in operative time between the L4-L5 and L5-S1 groups; the operative time was gradually decreased. The mean hospital stay was 2.9 days (range: 2-8 days). According to modified MacNab criteria, 20 cases (6 at L4-L5 and 14 at L5-S1) were excellent, 27 (10 at L4-L5 and 17 at L5-S1) were good, one at L5-S1 was fair, and 2 at L5-S1 were poor. Two perineurium tears occurred at L5-S1. There was no infection or recurrence of herniated nucleus pulposus (HNP). The clinical outcomes of PED-IL at L4-L5 were equal to those at L5- S1. Results: The mean operative time was 71.3 ± 19.3 minutes for all cases (range: 41-112 mins.),76.1 ± 16.8 minutes at L4-L5 (range: 52-102 mins.), and 70.5 ± 20.1 minutes at L5-S1 (range: 41-112 mins.). Limitations: A small sample size and a short follow-up period. Conclusions: The clinical outcomes of PED-IL at L4-L5 were equal to those at L5-S1. Therefore, PED-IL is suitable to be a standard method for any type of intracanalicular disc herniation. Keywords: Percutaneous full-endoscopic lumbar discectomy, interlaminar approach, clinical outcome, herniated nucleus pulpous, MacNab criteria, intracanalicular disc herniation, learning curve

scholarly journals Inter- and intra-examiner reliability of lumbar spine radiograph analysis by chiropractors and its impact on clinical management

2017 ◽  
Author(s):  
◽  
Zandile Mdakane
Keyword(s):  
Lumbar Spine ◽  
Case History ◽  
Clinical Management ◽  
Spinal Manipulative Therapy ◽  
Clinical History ◽  
Observer Agreement ◽  
Manipulative Therapy ◽  
Significant Difference ◽  
Spine Radiograph ◽  
Skeletal Disorders

Radiographs are the most commonly used modalities for the purpose of diagnosing skeletal disorders. Radiographs are important for chiropractors to exclude any contra-indications prior to spinal manipulative therapy. If contra-indications are found treatment is modified to what best suits each patient. There is a gap in the literature regarding chiropractors reading the same set of radiographs and agreeing on findings. Objectives The study investigated inter- and intra-examiner reliability of lumbar spine radiograph analysis by chiropractors and its impact on clinical management. Methods Inter- and intra-examiner examination of radiographs occurred in two rounds separated by two weeks. Six chiropractors read the same 30 radiographs and clinical history was only available in the second round. Results Inter-observer agreement for categorisation for Round One was 96.78% and Round Two 89.49%. Inter-observer agreement in management was 96.45% in round one and 96.00% in Round two. Agreement between chiropractors had no statistically significant difference. Identification average improved from 0.09 to 0.89 kappa. Overall specificity was relatively high and sensitivity was relatively low. Conclusion Reliability/Agreement between chiropractors was strong in both rounds. Categorising of the diagnosis improved from poor to substantial from Round One to Round Two. Case history improved the accuracy of interpreting the radiographs although this change was not statistically significant.

Effects of N-acetylcysteine on arterial neo-intimal hyperplasia in rat model of arteriovenous fistula

2018 ◽  
Vol 20 (2) ◽  
pp. 190-194
Author(s):  
Amirmohsen Jalaeefar ◽  
Arash Mohammadi Tofigh ◽  
Atoosa Gharib ◽  
Mohsen Khandaghy ◽  
Mohammad Reza Rahimi
Keyword(s):  
Arteriovenous Fistula ◽  
Rat Model ◽  
Intimal Hyperplasia ◽  
Intima Media Thickness ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Clinical Issue ◽  
Significant Difference ◽  
Hematoxylin And Eosin ◽  
The Mean

Introduction: Arteriovenous fistula is the best choice for vascular access in hemodialysis patients. However, arteriovenous fistula dysfunction is a major clinical issue. The most common cause of arteriovenous fistula failure is intimal hyperplasia. In this study, we have investigated the effect of N-acetylcysteine on neo-intimal hyperplasia after arteriovenous fistula creation in rats. Methods: This study was conducted in 24 rats which were randomly divided into two groups: control and N-acetylcysteine groups. An end-to-side anastomosis was made between the femoral artery and vein. The control group received distilled water intraperitoneally while the animals in N-acetylcysteine group received 300 mg/kg/day of N-acetylcysteine via the same route. After 28 days, the thickness of intima and media was measured using hematoxylin and eosin. Results: There was no significant difference between the two groups regarding age ( p = 0.6) and weight ( p = 0.1). The mean intima thickness in N-acetylcysteine group was significantly less than control group (17 ± 20 and 119 ± 46 µm, respectively; p < 0.001). The mean intima/media thickness in the N-acetylcysteine group was significantly less than control group (0.5 ± 0.63 vs 2.05 ± 1.17 µm; p < 0.001). Conclusion: N-acetylcysteine is effective in inhibiting neo-intimal hyperplasia in a rat model of arteriovenous fistula.

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