scholarly journals Clinical practice and postoperative rehabilitation after knee arthroscopy vary according to surgeons’ expertise: a survey among polish arthroscopy society members

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Paweł Bąkowski ◽  
Kamilla Bąkowska-Żywicka ◽  
Tomasz Piontek
Keyword(s):  
Knee Arthroscopy ◽  
Full Range ◽  
Postoperative Management ◽  
Meniscus Repair ◽  
Postoperative Treatment ◽  
Meniscus Tear ◽  
Postoperative Rehabilitation ◽  
Meniscus Suture ◽  
Surgical Expertise ◽  
Almost All

Abstract Background Meniscus repair is a challenging task in knee arthroscopy. Currently, there are a variety of arthroscopic methods available for meniscus repair. The purpose of this study was to determine a consensus in meniscus tear treatment in the environment of Polish orthopaedists. Methods A total of 205 registered orthopaedic surgeons participated in the surveys. The survey consisted of 35 questions regarding general arthroscopy and postoperative management, including physicians’ level of expertise, anaesthesia, postoperative treatment, rehabilitation and procedures performed. Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases) on aspects of patient care. Results The most important finding of this study was the agreement among almost all aspects of the knee arthroscopy approach. Consensus among Polish surgeons was noticed in choosing regional anaesthesia for knee arthroscopy, the lack of need for knee braces and knee medications, the of use of LMW heparin for thromboprophylaxis, 1–2 days of hospitalization, the recommendation of rehabilitation and the use of magnetic resonance as a diagnostic test for meniscus damage. Surgical expertise was significantly associated with the performance of meniscus suture procedures (p = 0.009). Experts recommended starting rehabilitation on the day of surgery (p = 0.007) and were more likely to use objective physical tests (p = 0.003). Non-expert surgeons recommended a longer period from meniscus suture to full-range knee motion (p = 0.001) and admitted that patient age does matter for meniscus repair qualification (p = 0.002). Conclusions There is consensus among almost all issues of meniscus tear treatment in the environment of Polish orthopaedists; however, the issues of rehabilitation and the use of advanced meniscus repair techniques are associated with surgical expertise.

scholarly journals Clinical practice and postoperative rehabilitation after knee arthroscopy vary according to surgeons’ expertise: a survey among Polish Arthroscopy Society members.

2020 ◽  
Author(s):  
Paweł Bąkowski ◽  
Kamilla Bąkowska-Żywicka ◽  
Tomasz Piontek
Keyword(s):  
Knee Arthroscopy ◽  
Full Range ◽  
Postoperative Management ◽  
Meniscus Repair ◽  
Postoperative Treatment ◽  
Meniscus Tear ◽  
Postoperative Rehabilitation ◽  
Meniscus Suture ◽  
Surgical Expertise ◽  
Almost All

Abstract Background: Meniscus repair is a challenging task in knee arthroscopy. Currently, there are a variety of arthroscopic methods available for meniscus repair. The purpose of this study was to determine a consensus in meniscus tear treatment in the environment of Polish orthopaedists.Methods: A total of 205 registered orthopaedic surgeons participated in the surveys. The survey consisted of 35 questions regarding general arthroscopy and postoperative management, including physicians’ level of expertise, anaesthesia, postoperative treatment, rehabilitation and procedures performed. Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases) on aspects of patient care.Results: The most important finding of this study was the agreement among almost all aspects of the knee arthroscopy approach. Consensus among Polish surgeons was noticed in choosing regional anaesthesia for knee arthroscopy, the lack of need for knee braces and knee medications, the of use of LMW heparin for thromboprophylaxis, 1-2 days of hospitalization, the recommendation of rehabilitation and the use of magnetic resonance as a diagnostic test for meniscus damage. Surgical expertise was significantly associated with the performance of meniscus suture procedures (p = 0.009). Experts recommended starting rehabilitation on the day of surgery (p=0.007) and were more likely to use objective physical tests (p=0.003). Non-expert surgeons recommended a longer period from meniscus suture to full-range knee motion (p=0.001) and admitted that patient age does matter for meniscus repair qualification (p=0.002).Conclusions: There is consensus among almost all issues of meniscus tear treatment in the environment of Polish orthopaedists; however, the issues of rehabilitation and the use of advanced meniscus repair techniques are associated with surgical expertise.

scholarly journals Clinical practice and post-operative rehabilitation after knee arthroscopy varies according to surgeon's expertise: a survey among Polish Arthroscopy Society members.

2020 ◽  
Author(s):  
Paweł Bąkowski ◽  
Kamilla Bąkowska-Żywicka ◽  
Tomasz Piontek
Keyword(s):  
Knee Arthroscopy ◽  
Full Range ◽  
Meniscal Repair ◽  
Postoperative Management ◽  
Meniscus Repair ◽  
Postoperative Treatment ◽  
Meniscus Tear ◽  
Meniscus Suture ◽  
Surgical Expertise ◽  
Almost All

Abstract Background: Meniscal repair has received increasing attention. Currently, there is a variety of arthroscopic methods of meniscus repair available. The purpose of this study was to determine a consensus in meniscus tear treatment in the environment of Polish orthopedists.Methods: 205 registered orthopedic surgeons took part in surveys. The survey consisted of 35 questions regarding general arthroscopy and postoperative management, including physician’s level of expertise, arthroscopy anesthesia, postoperative treatment, rehabilitation and procedures performed. Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases) on aspects of patient care.Results: The most important finding of this study is an agreement in almost all aspects of knee arthroscopy approach. A consensus between polish surgeons was noticed in choosing regional anesthesia for knee arthroscopy, no need for knee braces nor knee medications, using LMW heparin as thromboprophylaxis, 1-2 days hospitalization, recommendation of rehabilitation and magnetic resonance as a diagnostic test for meniscus damage. Surgical expertise was significantly associated with the performance of meniscus sewing procedures (p = 0.009). Experts recommended starting rehabilitation already on the day of surgery (p=0.007) and more likely used objective physical tests (p=0.003). Non-expert surgeons recommended longer period from meniscus suture to a full range knee motion (p=0.001) and admitted that patient’s age does matter for meniscus repair qualification (p=0.002).Conclusions: There is a consensus in almost all issues of meniscus tear treatment in the environment of the Polish orthopedists, however the rehabilitation issues and the use of advanced meniscus repair techniques is associated with surgical expertise.

scholarly journals Clinical Practice and Post-Operative Rehabilitation After Knee Arthroscopy: Comparison Between Polish Experts and Non-Experts.

2020 ◽  
Author(s):  
Paweł Bąkowski ◽  
Kamilla Bąkowska-Żywicka ◽  
Tomasz Piontek
Keyword(s):  
Clinical Practice ◽  
Knee Arthroscopy ◽  
Full Range ◽  
Postoperative Management ◽  
Postoperative Treatment ◽  
Clinical Practices ◽  
Meniscus Suture ◽  
Surgical Expertise ◽  
Almost All ◽  
Suturing Techniques

Abstract Background: The purpose of this study was to compare the clinical practices between polish expert and non-expert arthroscopy knee surgeons.Methods: 205 registered orthopedic surgeons took part in surveys. The survey included 35 questions regarding general arthroscopy and postoperative management, including physician’s level of expertise, arthroscopy anesthesia, postoperative treatment, rehabilitation and procedures performed. Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases) on aspects of patient care.Results: The most important finding of this study is an agreement in almost all aspects of knee arthroscopy approach. A consensus between polish surgeons was noticed in choosing regional anesthesia for knee arthroscopy, no need for knee braces nor knee medications, using LMW heparin as thromboprophylaxis, 1-2 days hospitalization, recommendation of rehabilitation and magnetic resonance as a diagnostic test for meniscus damage. Surgical expertise was significantly associated with the performance of meniscus sewing procedures (p = 0.009). Experts recommended starting rehabilitation already on the day of surgery (p=0.007) and more likely used objective physical tests (p=0.003). Nonexpert surgeons recommended longer period from meniscus suture to a full range knee motion (p=0.001) and admitted that patient’s age does matter for meniscus repair qualification (0.002).Conclusions: Clinical practice varies among orthopeadists performing knee arthroscopy procedures, based on their level of expertise. Polish knee arthroscopy experts agreed with non-experts in the type of anesthesia during knee arthroscopy and numerous aspects of postoperative treatment. Surgical expertise was associated with the performance of advanced meniscus suturing techniques.

scholarly journals Two Populations of Glucocorticoid Receptor-Binding Sites in the Male Rat Hippocampal Genome

Endocrinology ◽  
2013 ◽  
Vol 154 (5) ◽  
pp. 1832-1844 ◽  
Author(s):  
J. Annelies E. Polman ◽  
E. Ronald de Kloet ◽  
Nicole A. Datson
Keyword(s):  
Receptor Binding ◽  
Binding Sites ◽  
Glucocorticoid Receptors ◽  
Full Range ◽  
Male Rat ◽  
Motif Analysis ◽  
Wide Range ◽  
Neuronal Processes ◽  
Almost All

Abstract In the present study, genomic binding sites of glucocorticoid receptors (GR) were identified in vivo in the rat hippocampus applying chromatin immunoprecipitation followed by next-generation sequencing. We identified 2470 significant GR-binding sites (GBS) and were able to confirm GR binding to a random selection of these GBS covering a wide range of P values. Analysis of the genomic distribution of the significant GBS revealed a high prevalence of intragenic GBS. Gene ontology clusters involved in neuronal plasticity and other essential neuronal processes were overrepresented among the genes harboring a GBS or located in the vicinity of a GBS. Male adrenalectomized rats were challenged with increasing doses of the GR agonist corticosterone (CORT) ranging from 3 to 3000 μg/kg, resulting in clear differences in the GR-binding profile to individual GBS. Two groups of GBS could be distinguished: a low-CORT group that displayed GR binding across the full range of CORT concentrations, and a second high-CORT group that displayed significant GR binding only after administering the highest concentration of CORT. All validated GBS, in both the low-CORT and high-CORT groups, displayed mineralocorticoid receptor binding, which remained relatively constant from 30 μg/kg CORT upward. Motif analysis revealed that almost all GBS contained a glucocorticoid response element resembling the consensus motif in literature. In addition, motifs corresponding with new potential GR-interacting proteins were identified, such as zinc finger and BTB domain containing 3 (Zbtb3) and CUP (CG11181 gene product from transcript CG11181-RB), which may be involved in GR-dependent transactivation and transrepression, respectively. In conclusion, our results highlight the existence of 2 populations of GBS in the rat hippocampal genome.

scholarly journals Case Report of a Medial Femoral Condyle Fracture in a Unicompartmental Oxford Knee Replacement Surgery

2019 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Femoral Condyle ◽  
Intraoperative Complications ◽  
Weight Bearing ◽  
Full Range ◽  
Postoperative Rehabilitation ◽  
Medial Condyle ◽  
Case Presentation ◽  
Replacement Surgery ◽  
Stable Osteosynthesis ◽  
Condyle Fracture

Introduction: The unicompartmental Oxford prosthesis has been used as a goodalternative for medial unicompartmental osteoarthritis because it is associated with earlyrehabilitation and a low rate of intraoperative complications. This case describes a rarecomplication during the procedure. Case Presentation: We present an intraoperative fracture of the medial condyle in a 70-year-old woman that was treated with 6.5 mm cannulated screws with a compressiontechnique. The patient remained in a non-weight bearing protocol for 6 weeks andreached a full range of mobility at 3 months. Complete radiological consolidation and agood functional outcome were observed. Conclusion: Intraoperative fractures benefit from a stable osteosynthesis that allows freerange of mobility and does not delay postoperative rehabilitation.

scholarly journals RARE CASE OF SHORT BOWEL SYNDROME

2019 ◽  
Vol 49 ◽  
pp. 6-8
Author(s):  
Azmaiparashvili G. აზმაიფარაშვილი გ. ◽  
Tomadze G. თომაძე გ. ◽  
Megreladze A. მეგრელაძე ა.
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Rare Case ◽  
Postoperative Management ◽  
Hepatic Flexure ◽  
Postoperative Treatment ◽  
Extensive Resection ◽  
Short Bowel

Short bowel syndrome is characterized by malabsorption following extensive resection of the small bowel. It may occur after resection of more than 50% and is certain after resection of more than 70% of the small intestine, or if less than 100 cm of small bowel remains.  Successful postoperative management of short bowel syndrome has been discussed. Patient was operated because of cancer of hepatic flexure of large bowel with invasion in stomach, pancreas, retroperitoneal space, mesentery of small bowel. Right sided colectomy and excessive resection of small bowel with limphodissection was performed and only 80 cm of small bowel was left together with the left part of the colon. Ileotransversoanastomosis was performed. After the adequate course of chemotherapy and partial parenteral nutrition patient’s general condition became satisfactory. Patient started to gain weight. Adequate postoperative treatment determined postoperative period without surgical and nutritional complication.

scholarly journals MENISCUS REPAIR VERSUS DEBRIDEMENT FOR MENISCAL TEARS IN PEDIATRIC PATIENTS – PREDICTORS FOR TREATMENT BASED ON DEMOGRAPHICS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0016
Author(s):  
Lauren Agatstein ◽  
Alton W. Skaggs ◽  
Matthew J. Brown ◽  
Nicole Friel ◽  
Brian Haus
Keyword(s):  
Pediatric Patients ◽  
Private Insurance ◽  
Meniscal Repair ◽  
Meniscus Repair ◽  
Meniscus Tear ◽  
Children's Hospitals ◽  
Children's Hospital ◽  
Children’S Hospitals ◽  
Meniscus Tears ◽  
Children’S Hospital

BACKGROUND: Pediatric and adolescent patients with meniscus tears have a relatively high rate of healing after meniscus repair – up to greater than 80% in the literature. Despite this fact, many patients undergo meniscus debridement for treatment of their meniscus tears. In this study, we investigated the demographic factors predictive of whether a pediatric patient would receive a meniscal repair or a meniscal debridement for their meniscal tear. METHODS: The California statewide ambulatory surgery database (OSHPD) was queried for all patients under 18 years old who underwent meniscus debridement or meniscus repair from 2008-2016. The effect of age, hospital setting (adult versus pediatric hospital), injury chronicity, gender, insurance type, race, and year of service was assessed using logistic regression. RESULTS: A total of 13,906 pediatric patients had meniscal surgery during the timeframe. 83% (11,561/13,906) underwent meniscal debridement and 17% (2,345/13,906) underwent meniscal repair. Age, hospital type, nature of injury, gender, private insurance, being Hispanic, and year of service were statistically significant in predicting the odds of having meniscus repair versus meniscus debridement. Surgery at a children’s hospital increases the odds of having meniscus repair (p < 0.001). Of the 82.6% of pediatric patients (11,491/13,906) treated at non-children’s hospitals, 16% (1839) had repair and 84% underwent debridement (9,652). Of the 17.4% (2,415) treated at children’s hospitals, 21% (506) had repair and 79% (1,909) underwent debridement. As patients age, the odds of receiving a meniscus repair decrease (p < 0.001). Acute meniscus injury (p < 0.001) or private insurance (p < 0.05) increase the odds of having meniscus repair. However, females (p < 0.05) and Hispanics (p < 0.01) had decreased odds of having meniscus repair. As time between injury and surgery progressed, the odds of having meniscus repair versus meniscus debridement increased (p < 0.001). CONCLUSIONS: There is increasing evidence that pediatric patients have successful outcomes after meniscal repair surgery. The results of this study demonstrate that the majority of pediatric patients with meniscus tears undergo a meniscal debridement rather than a repair. Treatment at a children’s hospital, private insurance, and a short time frame between injury and surgery were positive predictors of meniscus repair over debridement. The results of the study may help inform patients, families, and referring physicians about what type of treatment a patient may receive for a meniscus tear, based on their demographic profile.

Cyclic Testing of Flexible All-Inside Meniscus Suture Anchors: Biomechanical Analysis

2005 ◽  
Vol 33 (3) ◽  
pp. 388-394 ◽  
Author(s):  
Thore Zantop ◽  
Ann K. Eggers ◽  
Volker Musahl ◽  
Andre Weimann ◽  
Wolf Petersen
Keyword(s):  
Cyclic Loading ◽  
Biomechanical Properties ◽  
Meniscus Repair ◽  
Biomechanical Analysis ◽  
Suture Techniques ◽  
Suture Anchors ◽  
Pull Out ◽  
Meniscus Suture ◽  
Significant Difference ◽  
Pull Out Strength

Background Flexible meniscus repair devices are designed to combine the benefits of rigid all-inside meniscus anchors with the biomechanical properties of sutures. Hypothesis Stiffness and pull-out strength of flexible all-inside suture anchors and conventional sutures under cyclic loading conditions will be comparable. Study Design Controlled laboratory study Methods In 50 fresh frozen bovine menisci, artificial meniscus lesions were repaired with different meniscus fixation techniques: horizontal and vertical FasT-Fix, RapidLoc, and horizontal and vertical 2-0 Ethibond sutures. The specimens were cycled 1000 times between 5 and 20 N and then loaded to failure. Results All devices survived the cyclic loading protocol. There was no significant difference in the displacement between all repair techniques tested (horizontal FasT-Fix, 6.23 mm; vertical FasT-Fix, 5.34 mm; RapidLoc, 6.84 mm; horizontal 2-0 Ethibond, 6.03 mm; vertical 2-0 Ethibond, 5.61 mm (P >. 05). Vertical and horizontal FasT-Fix suture anchors had a significantly higher stiffness and pull-out strength (94.1 N and 80.8 N, respectively) than did horizontal sutures (50.2 N) and RapidLoc devices (30.3 N) (P >. 05). Conclusions In this study, flexible all-inside meniscus anchors (FasT-Fix) had higher pull-out strength than did conventional vertical suture techniques. Biomechanical characteristics of the flexible RapidLoc are comparable to those of horizontal sutures. Clinical Relevance Flexible all-inside meniscus repair devices are an alternative to conventional suture techniques.

scholarly journals Cross-class metallo-β-lactamase inhibition by bisthiazolidines reveals multiple binding modes

2016 ◽  
Vol 113 (26) ◽  
pp. E3745-E3754 ◽  
Author(s):  
Philip Hinchliffe ◽  
Mariano M. González ◽  
Maria F. Mojica ◽  
Javier M. González ◽  
Valerie Castillo ◽  
...  
Keyword(s):  
Full Range ◽  
Drug Resistant ◽  
Binding Modes ◽  
X Ray ◽  
Free Thiol ◽  
Extensively Drug Resistant ◽  
Multiple Binding ◽  
Almost All ◽  
Time Kill

Metallo-β-lactamases (MBLs) hydrolyze almost all β-lactam antibiotics and are unaffected by clinically available β-lactamase inhibitors (βLIs). Active-site architecture divides MBLs into three classes (B1, B2, and B3), complicating development of βLIs effective against all enzymes. Bisthiazolidines (BTZs) are carboxylate-containing, bicyclic compounds, considered as penicillin analogs with an additional free thiol. Here, we show both l- and d-BTZ enantiomers are micromolar competitive βLIs of all MBL classes in vitro, with Kis of 6–15 µM or 36–84 µM for subclass B1 MBLs (IMP-1 and BcII, respectively), and 10–12 µM for the B3 enzyme L1. Against the B2 MBL Sfh-I, the l-BTZ enantiomers exhibit 100-fold lower Kis (0.26–0.36 µM) than d-BTZs (26–29 µM). Importantly, cell-based time-kill assays show BTZs restore β-lactam susceptibility of Escherichia coli-producing MBLs (IMP-1, Sfh-1, BcII, and GOB-18) and, significantly, an extensively drug-resistant Stenotrophomonas maltophilia clinical isolate expressing L1. BTZs therefore inhibit the full range of MBLs and potentiate β-lactam activity against producer pathogens. X-ray crystal structures reveal insights into diverse BTZ binding modes, varying with orientation of the carboxylate and thiol moieties. BTZs bind the di-zinc centers of B1 (IMP-1; BcII) and B3 (L1) MBLs via the free thiol, but orient differently depending upon stereochemistry. In contrast, the l-BTZ carboxylate dominates interactions with the monozinc B2 MBL Sfh-I, with the thiol uninvolved. d-BTZ complexes most closely resemble β-lactam binding to B1 MBLs, but feature an unprecedented disruption of the D120–zinc interaction. Cross-class MBL inhibition therefore arises from the unexpected versatility of BTZ binding.

scholarly journals Postoperative rehabilitation of patients with colloidal nodular goiter

2006 ◽  
Vol 5 (4) ◽  
pp. 97-102
Author(s):  
G. K. Zherlov ◽  
N. P. Rezantseva ◽  
D. V. Zykov ◽  
A. V. Karpovich ◽  
T. G. Zherlova
Keyword(s):  
Thyroid Gland ◽  
Postoperative Period ◽  
Physical Disability ◽  
Life Quality ◽  
Nodular Goiter ◽  
Postoperative Management ◽  
Hormonal Status ◽  
Postoperative Rehabilitation ◽  
Wound Reparation

The new method for the rehabilitation of patients operated on thyroid gland because of the colloidal nodular goiter has been suggested. The method includes the prescription of non-steroid anti-inflammatory nimesulide drug and microwaves during the earlier postoperative period in combination with the hormonal status correction. This rehabilitation method results in sooner wound reparation, shorter period of physical disability, and better life quality of patients comparing to traditional postoperative management.

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