Time to Resolution of Triggering after Steroid Injection for First Presentation Trigger Digits

Background: Steroid injection is a proven treatment for trigger digits. The time taken for resolution of triggering following an injection is a question often asked by patients and one that has not been adequately addressed in existing literature. The aim of this study was to determine the time taken for triggering to resolve after a single steroid injection in patients presenting for the first time with a trigger digit. Methods: A prospective study was conducted in patients with first presentation of a grade II or grade III trigger digit(s) that received a steroid injection. Data with regards to age, gender, digit(s) involved, duration of symptoms, trigger grade, and presence of diabetes were collected. They were given a stamped addressed postcard with instructions to fill in the date that the triggering resolved and mail the postcard back to us. If the postcard was not received at three weeks, we contacted the patient by telephone to ask for the date of resolution of trigger. Results: 56 patients with 66 trigger digits were included in the study. 52 out of 66 digits (79%) had resolution of the trigger at one month. The mean duration for resolution of trigger was 8.8 days (range 1–30 days). Conclusions: Patients can be counselled that a steroid injection is effective in resolving the trigger in 79% of trigger digits presenting for the first time and that the mean time taken for resolution of triggering is 8.8 days. It is recommended to wait for at least one month before considering another injection or alternative treatments.

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Sugammadex ED90 dose to reverse the rocuronium neuromuscular blockade in obese patients

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912017001010 ◽

2017 ◽

Vol 44 (1) ◽

pp. 41-45 ◽

Cited By ~ 1

Author(s):

MAURO PRADO DA SILVA ◽

CHRISTIANO MATSUI ◽

DANIEL DONGIOU KIM ◽

JOAQUIM EDSON VIEIRA ◽

CARLOS ALBERTO MALHEIROS ◽

...

Keyword(s):

Neuromuscular Blockade ◽

Obese Patients ◽

Minimum Effective Dose ◽

Nerve Stimulator ◽

Peripheral Nerve Stimulator ◽

Complete Reversal ◽

The Mean ◽

A Prospective Study ◽

Mean Time ◽

Grade Iii

ABSTRACT Objective: to determine the ED90 (minimum effective dose in 90% of patients) of sugammadex for the reversal of rocuronium-induced moderate neuromuscular blockade (NMB) in patients with grade III obesity undergoing bariatric surgery. Methods: we conducted a prospective study with the biased coin up-and-down sequential design. We chosen the following doses: 2.0mg/Kg, 2.2mg/Kg, 2.4mg/Kg, 2.6mg/Kg, 2.8mg/Kg. The complete reversal of rocuronium-induced NMB considered a T4/T1 ratio ≥0.9 as measured by TOF. After induction of general anesthesia and calibration of the peripheral nerve stimulator and accelerometer, we injected rocuronium 0.6mg/kg. We administered propofol and remifentanil by continuous infusion, and intermittent boluses of rocuronium throughout the procedure. Results: we evaluated 31 patients, of whom 26 had displayed successful reversal of the NMB with sugammadex, and failure in five. The mean time to complete moderate NMB reversal was 213 seconds (172-300, median 25-75%). The ED90 of sugammadex calculated by regression was 2.39mg/kg, with a 95% confidence interval of 2.27-2.46 mg/kg. Conclusion: the ED90 of sugammadex in patients with grade III obesity or higher was 2.39mg/kg.

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PRIMARY UNREAMED NAILING IN GRADE I, II AND IIIA OPEN FRACTURES OF THE TIBIA SHAFT: A PROSPECTIVE STUDY OF THE OUTCOMES IN 80 PATIENTS

Journal of Musculoskeletal Research ◽

10.1142/s021895771850015x ◽

2018 ◽

Vol 21 (03n04) ◽

pp. 1850015

Author(s):

S. K. Rai ◽

S. K. Nath ◽

Manoj Kashid ◽

Sunitkumar Wani

Keyword(s):

Prospective Study ◽

Bone Healing ◽

Deep Infection ◽

Tibial Shaft ◽

Shaft Fractures ◽

Unreamed Nailing ◽

Grade Ii ◽

A Prospective Study ◽

Mean Time ◽

Tibial Shaft Fractures

Introduction. To evaluate the incidences of union, nonunion and infection in the treatment of open tibial shaft fractures of Gustilo–Anderson types I, and IIIA treated with primary unreamed solid intramedullary locked nail (UTN). Materials and Methods. It is a prospective study of 80 open tibial shaft fractures. According to the AO classification, 36 patients (44%) were of type A, 29 (36%) were of type B and 15 (18%) were of type C. According to the Gustilo–Anderson classification, 31 patients (38.7%) were of grade I, 24 (30%) were of grade II and 25 (31%) were of grade IIIA. For the definitive stabilization of the fracture was used a UTN. Results. Bone healing was achieved in 98.4% of the cases, with a mean time of 24.2 weeks, ranging from 14 weeks to 110 weeks. Union without infection was seen in 70 patients (87%) and nonunion was seen in five patients (6%). Deep infection was seen in three patients (3.7%) and malunion was seen in two patients (2.5%). Conclusion. The treatment of open tibial shaft fractures with unreamed solid intramedullary locked nail allows high rates of bone healing and low rates of nonunion and deep infection, and if the presence of infection is excluded, then the results of unreamed nailing and reamed nailing are the same.

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Bench-top comparison of thermometers used in newborn infants

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-320123 ◽

2020 ◽

pp. fetalneonatal-2020-320123

Author(s):

Emma A Dunne ◽

Katie Cunningham ◽

Colm Patrick Finbarr O'Donnell ◽

Lisa K McCarthy

Keyword(s):

Steady State ◽

Prospective Study ◽

Newborn Infants ◽

Mean Difference ◽

Continuous Mode ◽

Control Temperature ◽

Steady State Temperature ◽

The Mean ◽

A Prospective Study ◽

Mean Time

We wished to determine the accuracy of thermometers used to measure temperature in newborn infants. We measured the temperature of a water bath with three types of thermometer set at 0.5°C increments between 32.5°C and 38.5°C and compared the values to a control. We recorded the time to display steady-state temperature. The Microlife thermometer most closely approximated control temperature (mean difference <0.1°C (SD<0.1°C)) and displayed a reading in a mean time of 29 s (SD 2 s). Used in ‘predictive’ (default) mode, the Welch Allyn SureTemp Plus 692 thermometer differed from the control by a mean of 0.6°C (SD 0.3°C), displaying a temperature at 15 s (SD 3 s). This device consistently overestimated temperature. In ‘continuous’ mode, the mean difference was <0.1°C (SD<0.1°C) at 5 min. The Phillips probe differed from the control by a mean of 0.4°C (SD 0.2°C). Thermometers used to measure temperature in newborn infants may underestimate hypothermia. A prospective study in newborn infants is needed.

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Evaluation of renal function in patients with psoriasis using immunobiologicals

Anais Brasileiros de Dermatologia ◽

10.1590/abd1806-4841.20132035 ◽

2013 ◽

Vol 88 (4) ◽

pp. 667-669 ◽

Cited By ~ 4

Author(s):

Sarah Suyanne Carvalho Melgaco ◽

Geraldo Bezerra da Silva Junior ◽

Amanda Maria Menezes Dantas ◽

Ana Mirella Arcanjo Vasconcelos ◽

Veronica Riquet de Siqueira ◽

...

Keyword(s):

Renal Function ◽

Prospective Study ◽

Creatinine Clearance ◽

The Mean ◽

A Prospective Study ◽

Mean Time

The aim of this study was to evaluate renal function in patients with psoriasis using immunobiologicals. A prospective study was conducted with 15 patients with confirmed diagnosis of psoriasis who were starting to use immunobiologicals. The mean age was 41±11 years, with 60% females. The mean time of disease was 11±6.6 years. Significant changes in creatinine and creatinine clearance were not observed in the course of the study. There was an increase in transaminases and a decrease in magnesium levels.

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Role of Immunohistochemical Markers p53 and Ki-67 in Grading of Glial Tumours: A Prospective Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46974.14768 ◽

2021 ◽

Author(s):

Aparna Singh ◽

Aparna Bhardwaj ◽

Sanjay Kaushik ◽

Sanjeev Kishore ◽

Seema Acharya

Keyword(s):

Prospective Study ◽

Tertiary Care ◽

Histologic Grade ◽

World Health ◽

Cell Of Origin ◽

Ki 67 ◽

Fixed Tissue ◽

Grade Ii ◽

The Mean ◽

A Prospective Study

Introduction: Gliomas are the tumours of neuroepithelial tissues and are named according to their cell of origin. Squash cytology and sterotactic biopsies with Haematoxylin and Eosin (H&E) staining form the backbone of diagnosis, nevertheless recent advances in Immunohistochemistry (IHC) have revolutionised the way gliomas are diagnosed and graded. Aim: To evaluate expression and correlation of p53 and Ki-67/MIB 1 amongst a series of gliomas diagnosed morphologically according to World Health Organisation (WHO) classification of Central Nervous System (CNS) tumours 2007. Materials and Methods: The present study was a prospective study conducted over a period of 18 months from December 2016 to May 2018 at a tertiary care centre in Uttarakhand, India. The study group comprised all consecutive cases of glial tumours that were clinically diagnosed and histopathologically confirmed as Gliomas during this period. Histopathological sections were made from formalin fixed tissue and stained with H&E and grading was done according to the WHO grading system 2007 for CNS neoplasms. Subsequently, IHC sections were taken on poly L-lysine coated slides and IHC staining of p53 and MIB1 (Ki-67) was performed. The IHC scores were calculated and correlated with histopathological grade. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 17.0. Results: A total of 40 cases of glial tumours diagnosed on histopatholgy were included in the study. They showed M:F ratio of 1.22:1 with peak age incidence of 21-30 years. Astrocytoma, grade IV was the most frequent diagnosis followed by grade II on H&E. On IHC, grade II diffuse astrocytomas, grade III Anaplastic Astrocytomas (AA), and Glioblastoma Multiforme (GBM) demonstrated a mean p53 positivity of 29.5, 50.83 and 47.66, respectively and a Ki-67 positivity of 32.5, 48.33 and 58.08, respectively. For ependymomas grade I, II and III the mean p53 positivity was 9, 5.26 and 12, respectively and the mean Ki-67 positivity was 2, 7.93 and 40, respectively. Amongst oligodendrogliomas grade II and III showed a p53 positivity of 6 and 8.25 and Ki-67 positivity of 12 and 30.5, respectively. A stronger correlation was found between an increase in histologic grade and proliferation markers. Conclusion: Histologic grade was the most important prognostic factor with respect to patient survival in glial neoplasms. The immunopositivity for p53 and Ki-67 correlated well with histological malignancy grade in all glioma subtypes, but a considerable overlap of proliferative index was observed between different subtypes.

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Anterior Submandibular Approach for Transmylohyoid Endotracheal Intubation: A Reappraisal with Prospective Study in 206 Cases of Craniomaxillofacial Fractures

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0037-1607063 ◽

2017 ◽

Vol 10 (4) ◽

pp. 255-262 ◽

Cited By ~ 2

Author(s):

Nitin Bhola ◽

Anendd Jadhav ◽

Atul Kala ◽

Rahul Deshmukh ◽

Umesh Bhutekar ◽

...

Keyword(s):

Prospective Study ◽

Dental Occlusion ◽

Withdrawal Time ◽

Incision And Drainage ◽

Ventilation Support ◽

The Mean ◽

Long Term Ventilation ◽

A Prospective Study ◽

Mean Time

Despite a paradigm shift in anesthesia and trauma airway management, the craniomaxillofacial fracture (CMF) patients continue to pose a challenge. A prospective study was planned between April 2007 and March 2015 to investigate the safety, efficacy, utility, and complications of anterior submandibular approach for transmylohyoid intubation (TMI) in CMFs using an armored endotracheal tube (ETT). Out of 1,207 maxillofacial trauma cases reported, this study recruited 206 patients (152 males and 54 females) aged between 21 and 60 years. No episode of oxygen desaturation was noted intraoperatively. Mean time to perform TMI was 6 ± 2 minutes. The mean transmylohyoid ETT withdrawal time/disconnection time from ventilator was approximately 1.5 minutes. Accidental partial extubation of ETT was noted in two patients (0.97%), and three patients (1.45%) developed abscess formations at anterior submandibular site which were managed by incision and drainage. The anterior submandibular approach for TMI was successfully used and provided stable airway in all elective CMF surgery cases, where oral or nasal intubations were not indicated/feasible and long-term ventilation support was not required. It permitted simultaneous dental occlusion-guided reduction and fixation of all the facial fractures without interference from the tube during the surgery with unhindered maintenance of the anesthesia and airway. The advantages include easy, swift, efficient, and reliable approach with a small learning curve.

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Evaluation of surgical treatment of medial patellar luxation in Pomeranian dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-12-11-0138 ◽

2013 ◽

Vol 26 (06) ◽

pp. 435-439 ◽

Cited By ~ 12

Author(s):

L. F. H. Theyse ◽

M. Techakumphu ◽

K. Soontornvipart ◽

H.A.W. Hazewinkel ◽

C. Wangdee

Keyword(s):

Surgical Treatment ◽

Prospective Study ◽

Success Rate ◽

Recurrence Rate ◽

Surgical Correction ◽

Grade Ii ◽

A Prospective Study ◽

Preoperative Score ◽

Outcome Of Surgery ◽

Grade Iii

SummaryIn a prospective study, the outcome of surgical correction of medial patellar luxation of 70 stifle joints in 55 Pomeranian dogs was evaluated. Trochlear block recession alone was performed in 46 stifle joints, or in combination with tibial tuberosity transposition in 24 stifle joints in cases with grade II, III or IV medial patellar luxation. Additional procedures were performed to restore lateral and medial retinacular function. The recurrence of patellar luxation and the degree of lameness were evaluated up to at least 16 weeks after surgery. The overall recurrence rate was 10%. The outcome of surgery was considered good for grade II luxation with a 100% success rate. Recurrent medial patellar luxation was diagnosed in approximately 11% of dogs with grade III and in 36% of dogs with grade IV luxation. The postoperative lameness score decreased significantly in comparison with the preoperative score at four weeks and thereafter until the end of the study.

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Marcher's Digitalgia Paresthetica Among Recruits

Foot & Ankle ◽

10.1177/107110078900900611 ◽

1989 ◽

Vol 9 (6) ◽

pp. 312-313 ◽

Cited By ~ 8

Author(s):

M. Stein ◽

N. Shlamkovitch ◽

A. Finestone ◽

C. Milgrom

Keyword(s):

Prospective Study ◽

Military Recruits ◽

Running Shoes ◽

The Mean ◽

A Prospective Study ◽

Mean Time ◽

Early Phases

In a prospective study of 30 male Israeli military recruits a 47% incidence of digitalgia paresthetica was found. The mean time of onset of symptoms was in the fourth week of training. The numbness was bilateral in 11 of 14 of the cases and the mean number of toes involved was 4.5. The first toe was the most commonly involved (11 of 14 patients). No correlation between shoe type (either 3/4 running shoes or standard military boots) was found. At 9-month follow-up, 7 of 9 affected recruits reviewed were asymptomatic. This finding suggests that marcher's digitalgia paresthetica is a neuropraxia. In this study, it developed during the early phases of march training when recruits are adapting to marching with heavy pack and rifle.

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Importance of a Follow-Up Ultrasound Protocol in Monitoring Posttraumatic Spleen Complications in Children Treated with a Non-Operative Management

Medicina ◽

10.3390/medicina57080734 ◽

2021 ◽

Vol 57 (8) ◽

pp. 734

Author(s):

Ivona Djordjevic ◽

Dragoljub Zivanovic ◽

Ivana Budic ◽

Ana Kostic ◽

Danijela Djeric

Keyword(s):

Splenic Abscess ◽

Operative Management ◽

High Energy ◽

Significant Difference ◽

Injury Grade ◽

Grade Ii ◽

The Mean ◽

Non Operative Management ◽

Grade Iii

Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications.

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