Spinal Fusion and Instrumentation for Paediatric Neuromuscular Scoliosis: Retrospective Review

Purpose. A retrospective study was conducted to review the surgical results among 24 patients with neuromuscular scoliosis, who were treated with spinal instrumentation and fusion at the Department of Orthopaedic Surgery, National University Hospital, Singapore between March 1993 and December 1998. Methods. We examined complete hospital records of patients who had scoliosis due to aetiologies such as spinal muscular atrophy, cerebral palsy, Duchenne muscular dystrophy, and congenital myopathies. The mean age of patients was 10.6 years (range, 6–14 years) and the mean follow-up duration was 5.5 years. Results. 18 patients had posterior surgery alone, whereas 4 had an anterior release with posterior instrumentation, and 2 had an anterior fusion with instrumentation. The mean length of stay in the intensive care unit was 2 days and the mean duration of hospital stay was 11 days. The mean correction in scoliosis angle ranged from 75.6° to 25.7°. All patients could at least sit without support postoperatively. The one-second forced expiratory volume and forced vital capacity were, in general, maintained throughout the follow-up. There were 2 major complications and 2 minor ones; these were pseudarthrosis with rod breakage requiring revision, deep infection necessitating hardware removal, superficial infection that responded to antibiotics, and urinary tract infection requiring 3 weeks of antibiotic treatment. There were no deaths or any neurological complications after instrumentation. Conclusion. Spinal stabilisation and fusion in children with neuromuscular scoliosis is a safe and effective treatment modality. The effect of surgery on long-term pulmonary function, however, remains controversial and needs to be addressed.

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Sagittal Plane Deformities in Children with SMA2 following Posterior Spinal Instrumentation

Children ◽

10.3390/children8080703 ◽

2021 ◽

Vol 8 (8) ◽

pp. 703

Author(s):

Matthew A. Halanski ◽

Rewais Hanna ◽

James Bernatz ◽

Max Twedt ◽

Sarah Sund ◽

...

Keyword(s):

Thoracic Kyphosis ◽

Sagittal Plane ◽

Muscular Atrophy ◽

Posterior Instrumentation ◽

Spinal Instrumentation ◽

Spinal Muscular Atrophy Type ◽

Growing Rods ◽

Sagittal Deformity

This is a retrospective radiographic review to assess post-operative sagittal plane deformities in patients with Spinal Muscular Atrophy type 2 that had been treated with posterior spinal instrumentation. Thirty-two patients with a history of either spinal fusion (N = 20) or growing rods (N = 12) were identified with an average of 7.6 (2.1–16.6) years post-operative follow-up. Forty percent (13/32) of the patients were identified as having obvious “tucked chin” (N = 4), “tipped trunk” (N = 9), or both (N = 3). Sacral incidence was the only parameter that was statistically significant change between pre-operative or immediate post-operative measurements (66.9° vs. 55.2° p = 0.03). However, at final follow-up, the post-operative thoracic kyphosis had decreased over time in those that developed a subsequent sagittal deformity (24.2°) whereas it increased in those that did not (44.7°, p = 0.008). This decrease in thoracic kyphosis throughout the instrumented levels, resulted in a greater lordotic imbalance (30.4° vs. 5.6°, p = 0.001) throughout the instrumented levels in the group that developed the subsequent cervical or pelvic sagittal deformities. In conclusion, sagittal plane deformities commonly develop outside the instrumented levels in children with SMA type 2 following posterior spinal instrumentation and may be the result of lordotic imbalance that occurs through continued anterior growth following posterior instrumentation.

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EVALUATION OF LONGO’S HEMORRHOIDECTOMY AT HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2012.6.10 ◽

2012 ◽

pp. 79-85

Author(s):

Van Lieu Nguyen ◽

Doan Van Phu Nguyen ◽

Thanh Phuc Nguyen

Keyword(s):

Hospital Stay ◽

Perioperative Complications ◽

University Hospital ◽

Anal Pain ◽

Stapled Hemorrhoidectomy ◽

Fourth Degree ◽

Duration Of Hospital Stay ◽

The Mean ◽

Good For

Introduction: Since Longo First described it in 1998, Stapled Hemorrhoidectomy has been emerging as the procedure of choice for symtomatic hemorrhoid. Several studies have shown it to be a safe, effective and relative complication free procedure. The aim of this study was to determine the suitability of (SH) as a day cas procedure at Hue University Hospital. Methods: From Decembre 2009 to April 2012, 384 patients with third- degree and fourth-degree hemorrhoids who underwent Stapled Hemorrhoidectomy were included in this study. Parameters recorded included postoperative complications, analegic requirements, duration of hospital stay and patient satisfaction. Follow-up was performed at 1 month and 3 months post-operative. Results: Of the 384 patients that underwent a Stapled Hemorrhoidectomy 252 (65,7%) were male and 132 (34,3%) were female. The mean age was 47,5 years (range 17-76 years. Duration of hospital stay: The mean day was 2,82 ± 1,15 days (range 1-6 days). There were no perioperative complications. There was one case postoperative complication: hemorrhage; Follow-up after surgery: 286 (74,4%) patients had less anal pain, 78 (20,3%) patients had moderate anal pain, 3 (0,8%) patients had urinary retention; Follow-up after one month: good for 325 (84,6%) patients, average for 59 (15,4%) patients; Follow-up after three months: good for 362 (94,3%) patients, average for 22 (5,7%) patients. Conclusion: Our present study shows that Stapled Hemorrhoidectomy is a safe, reduced postoperative pain, shorter hospital stay and a faster return to unrestricted daily activity

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Intraoperative cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy: a feasibility study

Urolithiasis ◽

10.1007/s00240-021-01259-1 ◽

2021 ◽

Author(s):

R. A. Kingma ◽

M. J. H. Voskamp ◽

B. H. J. Doornweerd ◽

I. J. de Jong ◽

S. Roemeling

Keyword(s):

Computed Tomography ◽

Percutaneous Nephrolithotomy ◽

Cone Beam Computed Tomography ◽

University Hospital ◽

Cone Beam ◽

Cross Sectional ◽

The Mean ◽

Residual Stones ◽

Residual Fragments

AbstractCone beam computed tomography (CBCT) provides multiplanar cross-sectional imaging and three-dimensional reconstructions and can be used intraoperatively in a hybrid operating room. In this study, we investigated the feasibility of using a CBCT-scanner for detecting residual stones during percutaneous nephrolithotomy (PCNL). Intraoperative CBCT-scans were made during PCNL procedures from November 2018 until March 2019 in a university hospital. At the point where the urologist would have otherwise ended the procedure, a CBCT-scan was made to image any residual fragments that could not be detected by either nephroscopy or conventional C-arm fluoroscopy. Residual fragments that were visualized on the CBCT-scan were attempted to be extracted additionally. To evaluate the effect of this additional extraction, each CBCT-scan was compared with a regular follow-up CT-scan that was made 4 weeks postoperatively. A total of 19 procedures were analyzed in this study. The mean duration of performing the CBCT-scan, including preparation and interpretation, was 8 min. Additional stone extraction, if applicable, had a mean duration of 11 min. The mean effective dose per CBCT-scan was 7.25 mSv. Additional extraction of residual fragments as imaged on the CBCT-scan occurred in nine procedures (47%). Of the follow-up CT-scans, 63% showed a stone-free status as compared to 47% of the intraoperative CBCT-scans. We conclude that the use of CBCT for the detection of residual stones in PCNL is meaningful, safe, and feasible.

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Follow-Up Care Barriers for Patients with Orofacial Clefts

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211042162 ◽

2021 ◽

pp. 105566562110421

Author(s):

Joshua Van Swol ◽

Bethany J. Wolf ◽

Julia Toumey ◽

Phayvanh Pecha ◽

Krishna G. Patel

Keyword(s):

Outcome Measure ◽

Tertiary Care ◽

University Hospital ◽

Exclusion Criteria ◽

Actual Patient ◽

The Mean ◽

Return Visits ◽

Significant Factors ◽

Patient Attendance

Objective The aim of this study was to evaluate whether a patient with a cleft's age, associated syndrome, cleft phenotype or travel distance affects their follow-up rate. Design This study is a retrospective review of patients with CL/P treated by a craniofacial clinic. Setting The setting was a craniofacial clinic at a tertiary care university hospital. Patients, Participants Candidates were patients seen by the craniofacial clinic between January 2007 and December 2019. An initial pool of 589 patients was then reduced to 440 due to exclusion criteria. Interventions None Main Outcome Measure(s) The outcome measure was actual patient attendance to the craniofacial team compared to the team goal expectation of annual return visits. Results The mean age of participants at the end of the study was 9.0 ± 5.4 years with a mean follow-up period (total possible follow-up period length based on patient age at presentation and study window) of 5.5 ± 3.6 years. There was no association between cleft phenotype, type of syndrome, or distance to the clinic with attendance. Children with syndromes had an 11% decrease in the odds of attending follow-up visits with each 1-year increase in age compared to a 4% decrease in children without syndromes. Conclusions The only significant factors determining patient attendance were the presence of a syndrome and increasing age.

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Comparison of Snodgross and para-meatal based flap technique for hypospadiasis

Annals of King Edward Medical University ◽

10.21649/akemu.v12i2.900 ◽

2016 ◽

Vol 12 (2) ◽

Author(s):

Jaffry S A H ◽

Naveed Iqbal ◽

Muhammad Nazir ◽

Khuda Dad Tarrar

Keyword(s):

Clinical Intervention ◽

Wound Dehiscence ◽

University Hospital ◽

Flap Technique ◽

External Meatus ◽

Good Cosmetic ◽

Watertight Closure ◽

The Mean ◽

Complications Rate

Objective: To compare the two surgical procedures Snod gross & parameatal based flap technique for mid & distal penile hypospadias including cosmosis. Study design: Randomized Clinical interventional trail. Place of study: This study was conducted in the Urology Department of Assir Central University Hospital ABHA, KSA and Department of Urology & Renal transplantation, Jinnah Hospital, Lahore from June 2002 to Dec 2004. Material & Methods: Thirty-two patients were selected for this randomized clinical intervention study with mid shaft & distal hypospadias fulfilling the inclusion criteria. Snod Gross and parameatal based flap technique was assigned randomly to patients comprising of two groups of sixteen each. Watertight closure was made with 6/0 vicryl. Tourniquet or 1:10000 epinephrine were used. Follow up at 2 weeks, three months; 6 months post catheter or stent removal and the patient were assessed on criteria of cosmosis, time for surgery and complications associated with the procedure. Results: Th irty-two patients who underwent procedure of Snodgross & parameatal-based flap in the management of mid shaft & distal penile Hypospadias. Age ranged from 2-12 years. The mean age was 5.23+4 years. The presentation of patients was dystocia of external meatus with misdirected stream in sixteen (50%) patients, spraying of urine in six (25%) and narrow stream in 4(13%) patients. Eighteen patients were having distal penile and fourteen were having mid shaft hypospadias. Following Snod grass technique all patients had good cosmetic results without any complication. Following parameatal based flap, one patients (6.3%) develop wound dehiscence, three patients (18.8%) develop urethral fistula, two patients (12.5%) showed metal retrieval and twenty patients showed good cosmosis. In our study, comparison between Snodgross & parameatal-based flap, the success rate was 100% and 62.4% respectively. Conclusions: Success with Snod gross procedure is better with no complications and good cosmosis. Complications rate was 37.6 % in-patient with para-meatal technique.

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EVALUATION OF THE RESULTS OF THE USE OF VEPTR IN PATIENTS WITH SCOLIOSIS

Coluna/Columna ◽

10.1590/s1808-185120161503147272 ◽

2016 ◽

Vol 15 (3) ◽

pp. 181-185

Author(s):

JOÃO PAULO SILVA ARAÚJO ◽

MARCOS ANDRÉ COSTA FERREIRA ◽

ANDRÉ FLAVIO FREIRE PEREIRA ◽

TULIO ALBUQUERQUE DE MOURA RANGEL ◽

RODRIGO CASTRO DE MEDEIROS ◽

...

Keyword(s):

Spinal Fusion ◽

Spinal Instrumentation ◽

Objective Evaluation ◽

Complication Rates ◽

Mean Values ◽

Fusion Methods ◽

The Mean ◽

Getulio Vargas ◽

Initial Correction

ABSTRACT Objective: Evaluation of the results of the use of VEPTR (Vertical Expandable Prosthetic Titanium Rib - Synthes Spine Co.(r), West Chester, Pennsylvania, USA) as an option in spinal instrumentation without fusion in younger children with scoliosis, considering the complications inherent to spinal fusion in this age group. Methods: Sixteen (16) patients with scoliosis, regardless of etiology, with a mean age of 5.2 (3-8) years, were followed up by Spine Surgery Group at Hospital Getúlio Vargas, Recite-PE, and were submitted to surgical correction of the deformity using VEPTR, from April/2009 to July/2014. The survey was conducted through medical register review, and photographic and radiographic records, with the measurement of pre- and postoperative curves by the Cobb method. Results: The mean values of Cobb angle in the preoperative period, in the immediate postoperative period and after the last distraction were, respectively, 84.1° (112°-60°), 55.4° (92°-16°) and 64.4° (100°-16°), with an average initial correction of 28.7° (34.1%) and final correction of 19.7° (23.4%). The mean follow-up was 23.1 (0-61) months with an average distraction of 3.1 (0-8). The complication rate in this study was 62.5%. Conclusion: The VEPTR presented considerable correction rates of scoliosis curves in patients whose age contraindicate the spinal fusion methods. It is necessary to improve the technique and the implant itself in order to reduce complication rates, which can be considered relatively high, in addition to the conduction of more studies with longer follow-up to determine the actual efficacy of the implant and the maintenance of long-term correction.

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Surgical treatment of degenerative and traumatic spinal diseases with expandable screws in patients with osteoporosis: 2-year follow-up clinical study

Journal of Neurosurgery Spine ◽

10.3171/2016.3.spine151294 ◽

2016 ◽

Vol 25 (5) ◽

pp. 610-619 ◽

Cited By ~ 15

Author(s):

Roberto Gazzeri ◽

Raffaelino Roperto ◽

Claudio Fiore

Keyword(s):

Pedicle Screw ◽

Spinal Instrumentation ◽

Pedicle Screws ◽

Posterior Fixation ◽

Spinal Diseases ◽

Fixation Failure ◽

Increased Risk ◽

Screw Breakage ◽

The Mean

OBJECTIVE Pedicle screw instrumentation of the osteoporotic spine carries an increased risk of screw loosening, pullout, and fixation failure. A variety of techniques have been used clinically to improve pedicle screw fixation in the presence of compromised bone. Pedicle screws may be augmented with cement, but this may lead to cement leakage and result in disastrous consequences. To avoid these complications, a multiaxial expandable pedicle screw has been developed. This was a prospective, single-center study designed to evaluate the clinical results of patients with osteoporosis with traumatic and degenerative spinal diseases treated with expandable pedicle screws. METHODS Thirty-three patients (mean age 61.4 years) with osteoporosis and traumatic or degenerative spinal diseases underwent spinal posterior fixation with expandable screws. Preoperative and postoperative visual analog scale (VAS) for pain and Oswestry Disability Index (ODI) questionnaire scores were obtained. The immediate postoperative screw position was measured and compared with the final position on lateral plain radiographs and axial CT scans at the 1- and 2-year follow-up examinations. RESULTS A total of 182 pedicle screws were used, including 174 expandable and 8 regular screws. The mean preoperative patient VAS score improved from 8.2 to 3.6 after surgery. The mean ODI score improved from 83.7% before surgery to 29.7% after the operation and to 36.1% at the final follow-up. No screw migration had occurred at the 1-year follow-up, but 1 screw breakage/migration was visualized on spinal radiography at the 2-year follow-up. CONCLUSIONS The results of this study show that the multiaxial expandable pedicle screw is a safe and practical technique for patients with osteoporosis and various spinal diseases and adds a valuable tool to the armamentarium of spinal instrumentation.

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Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

Infection Control and Hospital Epidemiology ◽

10.1086/588201 ◽

2008 ◽

Vol 29 (6) ◽

pp. 510-516 ◽

Cited By ~ 97

Author(s):

M. Buehlmann ◽

R. Frei ◽

L. Fenner ◽

M. Dangel ◽

U. Fluckiger ◽

...

Keyword(s):

University Hospital ◽

Highly Effective ◽

The Mean ◽

Treatment Analysis ◽

Refusal To Participate ◽

Intent To Treat ◽

Mrsa Colonization ◽

Treat Analysis ◽

Full Body

Objective.To evaluate the efficacy of a standardized regimen for decolonization of methicillin-resistantStaphylococcus aureus(MRSA) carriers and to identify factors influencing decolonization treatment failure.Design.Prospective cohort study from January 2002 to April 2007, with a mean follow-up period of 36 months.Setting.University hospital with 750 beds and 27,000 admissions/year.Patients.Of 94 consecutive hospitalized patients with MRSA colonization or infection, 32 were excluded because of spontaneous loss of MRSA, contraindications, death, or refusal to participate. In 62 patients, decolonization treatment was completed. At least 6 body sites were screened for MRSA (including by use of rectal swabs) before the start of treatment.Interventions.Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Intestinal and urinary-tract colonization were treated with oral vancomycin and cotrimoxazole, respectively. Vaginal colonization was treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution. Other antibiotics were added to the regimen if treatment failed. Successful decolonization was considered to have been achieved if results were negative for 3 consecutive sets of cultures of more than 6 screening sites.Results.The mean age (± standard deviation [SD]) age of the 62 patients was 66.2 ± 19 years. The most frequent locations of MRSA colonization were the nose (42 patients [68%]), the throat (33 [53%]), perianal area (33 [53%]), rectum (36 [58%]), and inguinal area (30 [49%]). Decolonization was completed in 87% of patients after a mean (±SD) of 2.1 ± 1.8 decolonization cycles (range, 1-10 cycles). Sixty-five percent of patients ultimately required peroral antibiotic treatment (vancomycin, 52%; cotrimoxazole, 27%; rifampin and fusidic acid, 18%). Decolonization was successful in 54 (87%) of the patients in the intent-to-treat analysis and in 51 (98%) of 52 patients in the on-treatment analysis.Conclusion.This standardized regimen for MRSA decolonization was highly effective in patients who completed the full decolonization treatment course.

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Assessment of the Efficacy of Photodynamic Therapy in Patients with Chronic Central Serous Chorioretinopathy

Czech and Slovak Ophthalmology ◽

10.31348/2019/6/2 ◽

2020 ◽

Vol 75 (6) ◽

pp. 298-308

Author(s):

Kateřina Manethová ◽

Jan Ernest ◽

Michal Hrevuš ◽

Naďa Jirásková

Keyword(s):

Photodynamic Therapy ◽

Central Serous Chorioretinopathy ◽

Functional Results ◽

University Hospital ◽

Prospective Clinical Study ◽

Chronic Central Serous Chorioretinopathy ◽

Chronic Form ◽

Before And After ◽

The Mean

Purpose: The aim of this prospective clinical study was to evaluate the anatomical and functional results of the treatment of 54 eyes with chronic form of central serous chorioretinopathy (CSC) using photodynamic therapy in a reduced (half) verteporfin (HD-PDT) dosing regimen. Materials and Methods: Our prospective study included 54 eyes of 52 patients (40 males, 12 females) at an average age of 50.1 years (median 49.5, range 30–75 years) treated at the Ophthalmology Clinic of the First Faculty of Medicine and Military University Hospital in Prague from January 2012 to January 2018 for chronic form of CSC with a minimum disease duration of 3 months. In our study, we evaluated the improvement of the best corrected visual acuity (BCVA) and central retinal thickness (CRT) before treatment and at 1, 3, 6 and 12 months after HD-PDT. Results: The mean baseline BCVA was 68.91 ± 10.5 ETDRS letters (median 71; range 35–85) and the mean baseline CRT was 385.6 ± 118.5 µm (median 367, 5 µm; range 245–1000 µm). At the end of the follow-up period, the average BCVA was 79 ± 11 ETDRS letters (median 82; range 38–93). The improvement in BCVA before and after treatment was statistically significant in all measurements (p < 0.0001). The mean CRT at the end of the follow-up period was 263.5 ± 52 µm (median 258.5 µm; range 162–404 µm). The decrease in CRT at all timepoints was statistically significant compared to baseline (p < 0.0001). In our set of patients, at the end of the follow-up period, the retinal finding was improved or stabilized in 50 eyes (92.6 %). In this study, we observed in 2 cases the development of secondary choroidal neovascularization (CNV). Conclusion: HD-PDT is a long-term safe and effective method of treating chronic forms of CSC. However, despite a reduced dose of verteporfin, complications may occur.

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An intervention of physical activity promotion in an university hospital. A prospective cohort study

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.373 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J Ladner ◽

S D Mihailescu ◽

D Cerasuolo

Keyword(s):

Physical Activity ◽

Health Workers ◽

Public Health Intervention ◽

Physical Activity Promotion ◽

University Hospital ◽

Activity Promotion ◽

The Mean ◽

High Level ◽

The Impact

Abstract Background Rouen University Hospital implements a policy of health promotion hospital since 2016. The objective of this study was to evaluate prospectively the impact of physical activity promotion in hospital health workers (HW), using pedometers over a period of six months. Methods Physical activity was measured by electronic pedometers distributed to HW, with the aim to improve their physical activity and to measure it during six months. Online questionnaires collected at different points of follow-up, from inclusion to sixth month (a total of seven points of follow-up). Socio-demographic and characteristics on type of health work were collected as well as the number of steps and the behavior regarding their routine physical activity. Results A total of 680 HW were included in the cohort. The sex ratio M:W was 0.16. The mean age was 41.6 years (SD = 10.7). 44.0% were non-medical caregivers, 32.1% were in administrative section, 14.3% were technical workers and 9.7% were physicians or pharmacists; 53.7% of HW reported doing sport regularly. At inclusion the mean number of daily steps was 8662. The mean progression for all professional profiles between first week and sixth month was of 1082 steps daily, with difference according to position: 1319 in physicians, 1234 in non-medical caregivers, 1106 in administrative workers and 314 in technical workers. In linear regression model, the mean number of progression of daily steps was 964 in physicians, 752 in non-medical caregivers. Conclusions The study shows a significant increase in the number of daily steps measured objectively using an incentive tool, as pedometer during six months of intervention. Further researches are needed to determine if these changes are sustainable over a long period of time Key messages Despite high level of daily steps at baseline, the longitudinal study shows an increase of daily steps over a 6-month period. Such public health intervention is a relevant method to engage people in self-monitoring their physical activity.

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