scholarly journals Low intensity pulsed ultrasound (LIPUS) use for the management of instrumented, infected, and fragility non-unions: a systematic review and meta-analysis of healing proportions

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ross Leighton ◽  
Mark Phillips ◽  
Mohit Bhandari ◽  
Robert Zura
Keyword(s):  
Quality Of Life ◽  
Fragility Fracture ◽  
Literature Search ◽  
Case Series ◽  
Pulsed Ultrasound ◽  
Non Union ◽  
Low Intensity Pulsed Ultrasound ◽  
Low Intensity

Abstract Background Non-union occurs in approximately 5 to 10% of fracture patients, with certain bones at greater risk of failing to heal. Non-unions have a significant impact on socioeconomic costs and the patients short and long-term quality of life. Low intensity pulsed ultrasound (LIPUS) is a non-invasive therapy for non-union treatment that can improve the long-term outcome. The purpose of this study is to summarize the available literature assessing LIPUS potential to improve the union rate in instrumented, infected, and fragility non-unions. Methods A literature search was conducted in the MEDLINE, EMBASE, and CINAHL databases for all relevant literature on the healing rates of LIPUS utilized in instrumented, infected, and fragility non-unions. Study characteristics were summarized for each of the included studies. The percentage of healed patients (healing rate), for instrumented, infected, and fragility fracture non-union patients were pooled from each included study. Results The literature search identified a total of 326 articles, while searching reference lists and grey literature identified an additional 3 articles. There was a total of 29 articles included in this review, with 20 articles included within the quantitative synthesis of healing rates. The most common design of included studies was case series (17 articles), followed by case reports (9 articles). Studies were primarily retrospective (18 studies), with an additional 10 prospective studies. Non-union healing rates were 82% (95% CI: 76 to 87%) in instrumented, 82% (95% CI: 70 to 95%) in infected, and 91% (95% CI: 87 to 95%) in fragility fracture patients with non-unions. Conclusion This study has provided a thorough overview of the current literature on LIPUS treatment for instrumented, infected, and fragility fracture non-unions. The healing rates for non-unions in these subgroups were comparable to healing rates observed with LIPUS use in general non-union literature. LIPUS treatment should be considered as a conservative non-surgical treatment option to potentially reduce the socioeconomic impact and improve the quality of life of these unfortunate patients. Level of evidence 4 (systematic review of primarily case series data)

scholarly journals How the Future of Sonography May Change the Outlook for Patients With Osteosarcoma

2018 ◽  
Vol 34 (5) ◽  
pp. 368-373
Author(s):  
Stacey Hoya ◽  
Linda Wogeman ◽  
Sara Allstadt ◽  
Glen King
Keyword(s):  
Quality Of Life ◽  
Focused Ultrasound ◽  
Treatment Plan ◽  
Treatment Options ◽  
Therapeutic Ultrasound ◽  
Bone Lesions ◽  
Pulsed Ultrasound ◽  
Low Intensity Pulsed Ultrasound ◽  
Ultrasound Applications

Sonography currently provides a variety of tools to support the diagnosis and treatment of osteosarcoma and, with the development of therapeutic ultrasound practices, could play an increasingly important role in the treatment of future patients with osteosarcoma. Currently, computed tomography, magnetic resonance imaging, and radiography are the preferred imaging modalities for bone lesions; treatment options for osteosarcoma primarily include highly toxic chemotherapies and surgeries that often result in limb loss. Unfortunately, osteosarcoma is rarely eliminated, and despite this, patients lose their lives after having a significant reduction in quality of life. Evolving therapies such as high-frequency focused ultrasound, ultrasound-enhanced delivery of photodynamic therapy, and low-intensity pulsed ultrasound may offer these patients an improved quality of life while also increasing efficacy of treatment. This canine case study illustrates the various ways in which sonography might contribute to the treatment plan for patients with osteosarcoma. It may provide a comparable model for the reimagining of treatment for future patients with osteosarcoma using a suite of therapeutic ultrasound applications.

Long-term Outcomes of Deep Brain Stimulation for Neuropathic Pain

Neurosurgery ◽  
2012 ◽  
Vol 72 (2) ◽  
pp. 221-231 ◽  
Author(s):  
Sandra G.J. Boccard ◽  
Erlick A.C. Pereira ◽  
Liz Moir ◽  
Tipu Z. Aziz ◽  
Alexander L. Green
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Short Form ◽  
Case Series ◽  
Mcgill Pain Questionnaire ◽  
Euroqol 5D ◽  
Deep Brain

Abstract BACKGROUND: Deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy has reported variable outcomes and has gained United Kingdom but not USA regulatory approval. OBJECTIVE: To prospectively assess long-term efficacy of DBS for chronic neuropathic pain in a single-center case series. METHODS: Patient reported outcome measures were collated before and after surgery, using a visual analog score, short-form 36-question quality-of-life survey, McGill pain questionnaire, and EuroQol-5D questionnaires (EQ-5D and health state). RESULTS: One hundred ninety-seven patients were referred over 12 years, of whom 85 received DBS for various etiologies: 9 amputees, 7 brachial plexus injuries, 31 after stroke, 13 with spinal pathology, 15 with head and face pain, and 10 miscellaneous. Mean age at surgery was 52 years, and mean follow-up was 19.6 months. Contralateral DBS targeted the periventricular gray area (n = 33), the ventral posterior nuclei of the thalamus (n = 15), or both targets (n = 37). Almost 70% (69.4%) of patients retained implants 6 months after surgery. Thirty-nine of 59 (66%) of those implanted gained benefit and efficacy varied by etiology, improving outcomes in 89% after amputation and 70% after stroke. In this cohort, >30% improvements sustained in visual analog score, McGill pain questionnaire, short-form 36-question quality-of-life survey, and EuroQol-5D questionnaire were observed in 15 patients with >42 months of follow-up, with several outcome measures improving from those assessed at 1 year. CONCLUSION: DBS for pain has long-term efficacy for select etiologies. Clinical trials retaining patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.

Welfare of cats 5–29 months after perineal urethrostomy: 74 cases (2015–2017)

2019 ◽  
Vol 22 (6) ◽  
pp. 582-588 ◽  
Author(s):  
Margaret R Slater ◽  
Sharon Pailler ◽  
J’mai M Gayle ◽  
Illoneete Cohen ◽  
Erin L Galloway ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Case Series ◽  
Life Outcomes ◽  
Retrospective Case ◽  
Quality Of Life Scale ◽  
Life Scale ◽  
Potential Factors ◽  
American Society

Objectives The objective of this study was to evaluate the long-term quality of life in cats following perineal urethrostomy. Methods This study comprised a retrospective case series of 74 cats with urinary obstructions that received perineal urethrostomies at the American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Hospital between September 2015 and July 2017. Medical records were reviewed for information on the number of obstructions prior to surgery, urinary tract problems at the time of surgery and other potential factors influencing long-term welfare. Owners were surveyed by telephone and text 5–29 months after their cat’s surgery. Responses were compiled and analyzed to determine owner perception of welfare postsurgery, and to identify patterns in medical history and welfare outcomes. Results In total, 105 cat owners were eligible for the survey; 74 responded. Altogether, 100% of responding individuals reported at least the same quality of life postsurgery compared with the cat’s quality of life before demonstrating urinary problems (48% reported better). On a quality-of-life scale of 1–10 (10 = excellent), 100% of responding cat owners reported at least 7; 75% reported 10. Conclusions and relevance Quality-of-life outcomes for cats 5–29 months after receiving perineal urethrostomy surgery were reported to be very good. Given this finding, and that perineal urethrostomy surgery should mitigate future blockages, we suggest considering perineal urethrostomy surgery as a standard tool to manage urinary obstructions in cats. The needs of the specific client and patient, including risks, costs and welfare of the cats, should drive the options for management of urinary obstructions in male cats.

Facilitation of fracture repair using low-intensity pulsed ultrasound

2000 ◽  
Vol 13 (04) ◽  
pp. 158-164 ◽  
Author(s):  
W. T. Wong ◽  
K. L. Bennell ◽  
J. M. McMeeken ◽  
J. D. Wark ◽  
S. J. Warden
Keyword(s):  
Bone Fractures ◽  
Delayed Union ◽  
Fracture Repair ◽  
Pulsed Ultrasound ◽  
Non Union ◽  
Veterinary Practice ◽  
Low Intensity Pulsed Ultrasound ◽  
Low Intensity ◽  
Fresh Fracture ◽  
Practical Implications

SummaryA recent application of ultrasound (US) therapy is to bone fractures. In two randomized controlled trials in humans, specific dosed US accelerated fresh tibial and radial fracture repair by 38%. When applied to delayed- and non-unions the same dosed US resulted in union in over 80% of cases. Similar US may augment fracture repair in veterinary practice. This paper reviews US dosages applied during fracture repair and their effect on bone healing. It concludes by discussing the clinical and practical implications of these findings to veterinary practice and the need for further research into this electrotherapeutic modality.Low-intensity pulsed ultrasound has been shown to facilitate fresh fracture repair, reduce the incidence of delayed-union and initiate healing of fractures displaying delayedand non-union. This paper discusses these findings and their implications to veterinary practice.

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