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

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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Arthroscopic Resection of Dorsal Wrist Ganglion: Results and Rate of Recurrence Over a Minimum Follow-up of 4 Years

Hand ◽

10.1177/1558944717743601 ◽

2017 ◽

Vol 14 (2) ◽

pp. 236-241 ◽

Cited By ~ 1

Author(s):

Carlos H. Fernandes ◽

Lia M. Meirelles ◽

Jorge Raduan Neto ◽

Marcela Fernandes ◽

João Baptista G. dos Santos ◽

...

Keyword(s):

Grip Strength ◽

Full Range ◽

Objective Evaluation ◽

Complication Rates ◽

Tumor Type ◽

Recurrence Rates ◽

Study Support ◽

The Mean ◽

Dorsal Wrist Ganglion

Background: Dorsal wrist ganglia are the most common soft tissue tumor type of the upper limb. Surgical resection, open or arthroscopic, is one of the most frequent procedures performed by hand surgeons. This study sought to perform an objective evaluation of the outcomes of arthroscopic resection of dorsal wrist ganglia and their recurrence rates over 4 years. Patients treated with arthroscopic resection were expected to have favorable outcomes and low complication rates after 4 years of follow-up. Methods: We evaluated 34 cases of dorsal wrist ganglia in patients who underwent arthroscopic resection. The patients were evaluated using the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) for pain, range of motion of the wrist, palmar grip strength, rates of recurrence, and complications. Results: During the postoperative period, the QuickDASH score averaged 2.3 points, the mean residual pain by VAS was 0.54, full range of wrist movement was recovered by all patients, and the mean palmar grip strength was 29.4 kgf; there was 1 case with recurrence. There were no severe postoperative complications throughout the follow-up period. Conclusions: The outcomes, recurrence, and complications rates after 4 years of follow-up presented in this study support the use of arthroscopy as a treatment for dorsal wrist ganglion.

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Rate of instrumentation changes on postoperative and follow-up radiographs after primary complex spinal fusion (five or more levels) for adult deformity correction

Journal of Neurosurgery Spine ◽

10.3171/2018.9.spine18686 ◽

2019 ◽

Vol 30 (3) ◽

pp. 376-381

Author(s):

Aladine A. Elsamadicy ◽

David T. Lubkin ◽

Amanda R. Sergesketter ◽

Syed M. Adil ◽

Lefko T. Charalambous ◽

...

Keyword(s):

Spinal Fusion ◽

Spine Surgery ◽

Deformity Correction ◽

The United States ◽

Spine Deformity ◽

Complication Rates ◽

Old Patients ◽

Primary Complex ◽

The Mean

OBJECTIVEIn the United States, healthcare expenditures have been soaring at a concerning rate. There has been an excessive use of postoperative radiographs after spine surgery and this has been a target for hospitals to reduce unnecessary costs. However, there are only limited data identifying the rate of instrumentation changes on radiographs after complex spine surgery involving ≥ 5-level fusions.METHODSThe medical records of 136 adult (≥ 18 years old) patients with spine deformity undergoing elective, primary complex spinal fusion (≥ 5 levels) for deformity correction at a major academic institution between 2010 and 2015 were reviewed. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient. The authors reviewed the first 5 subsequent postoperative and follow-up radiographs, and determined whether revision of surgery was performed within 5 years postoperatively. The primary outcome investigated in this study was the rate of hardware changes on follow-up radiographs.RESULTSThe majority of patients were female, with a mean age of 53.8 ± 20.0 years and a body mass index of 27.3 ± 6.2 kg/m2 (parametric data are expressed as the mean ± SD). The median number of fusion levels was 9 (interquartile range 7–13), with a mean length of surgery of 327.8 ± 124.7 minutes and an estimated blood loss of 1312.1 ± 1269.2 ml. The mean length of hospital stay was 6.6 ± 3.9 days, with a 30-day readmission rate of 14.0%. Postoperative and follow-up change in stability on radiographs (days from operation) included: image 1 (4.6 ± 9.3 days) 0.0%; image 2 (51.7 ± 49.9 days) 3.0%; image 3 (142.1 ± 179.8 days) 5.6%; image 4 (277.3 ± 272.5 days) 11.3%; and image 5 (463.1 ± 525.9 days) 15.7%. The 3rd year after surgery had the highest rate of hardware revision (5.55%), followed by the 2nd year (4.68%), and the 1st year (4.54%).CONCLUSIONSThis study suggests that the rate of instrumentation changes on radiographs increases over time, with no changes occurring at the first postoperative image. In an era of cost-conscious healthcare, fewer orders for early radiographs after complex spinal fusions (≥ 5 levels) may not impact patient care and can reduce the overall use of healthcare resources.

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Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

Urologia Internationalis ◽

10.1159/000371726 ◽

2015 ◽

Vol 95 (1) ◽

pp. 44-49 ◽

Cited By ~ 1

Author(s):

Maria Angela Cerruto ◽

Carolina D'Elia ◽

Francesca Maria Cavicchioli ◽

Stefano Cavalleri ◽

Matteo Balzarro ◽

...

Keyword(s):

Uterine Prolapse ◽

Pelvic Organ ◽

Consecutive Series ◽

Complication Rates ◽

Early Complications ◽

Robot Assisted ◽

Female Patients ◽

The Mean ◽

Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

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Impact of comprehensive management on clinical outcomes in hypertensive patients with coronary artery disease: HIJ-CREATE sub-study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2796 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Ogawa ◽

H Sekiguchi ◽

K Jujo ◽

E Kawada-Watanabe ◽

H Arashi ◽

...

Keyword(s):

Coronary Artery Disease ◽

Primary Outcome ◽

Ldl Cholesterol ◽

Lipid Lowering ◽

Hypertensive Patients ◽

Mean Values ◽

Comprehensive Management ◽

The Mean ◽

Artery Disease

Abstract Background There are limited data on the effects of blood pressure (BP) control and lipid lowering in secondary prevention of coronary artery disease (CAD) patients. We report a secondary analysis of the effects of BP control and lipid management in participants of the HIJ-CREATE, a prospective randomized trial. Methods HIJ-CREATE was a multicenter, prospective, randomized, controlled trial that compared the effects of candesartan-based therapy with those of non-ARB-based standard therapy on major adverse cardiac events (MACE; a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke, and other cardiovascular events requiring hospitalization) in 2,049 hypertensive patients with angiographically documented CAD. In both groups, titration of antihypertensive agents was performed to reach the target BP of <130/85 mmHg. The primary endpoint was the time to first MACE. Incidence of endpoint events in addition to biochemistry tests and office BP was determined during the scheduled 6, 12, 24, 36, 48, and 60-month visits. Achieved systolic BP and LDL-Cholesterol (LDL-C) level were defined as the mean values of these measurements in patients who did not develop MACEs and as the mean values of them prior to MACEs in those who developed MACEs during follow-up. Results During a median follow-up of 4.2 years (follow-up rate of 99.6%), the primary outcome occurred in 304 patients (30.3%). Among HIJ-CREATE participants, 905 (44.2%) were prescribed statins on enrollment. Kaplan–Meier curves for the primary outcome revealed that there was no relationship between statin therapy and MACEs in hypertensive patients with CAD. The original HIJ-CREATE population was divided into 9 groups based on equal tertiles based on mean achieved BP and LDL-C during follow-up. For the analysis of subgroups, estimates of relative risk and the associated 95% CIs were generated with a Cox proportional-hazards model (Figure 1). The relation between LDL cholesterol level and hazard ratios for MACEs was nonlinear, with a significant increase of MACEs only in the patients with inadequate controlled LDL-C level even in the patients with tightly controlled BP. Conclusions The results of the post-hoc analysis of the HIJ-CREATE suggest that clinicians should pay careful attention to conduct comprehensive management of lipid lowering even in the contemporary BP lowering for the secondary prevention in hypertensive patients with CAD. Figure 1 Funding Acknowledgement Type of funding source: None

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Lateral Antebrachial Cutaneous Nerve as a Donor Source for Digital Nerve Grafting: A Concept Revisited

The Open Orthopaedics Journal ◽

10.2174/1874325001711011041 ◽

2017 ◽

Vol 11 (1) ◽

pp. 1041-1048 ◽

Cited By ~ 4

Author(s):

Mehmet Bekir Unal ◽

Kemal Gokkus ◽

Evrim Sirin ◽

Eren Cansü

Keyword(s):

Pearson Correlation ◽

Mean Value ◽

Cutaneous Nerve ◽

Digital Nerve ◽

Mean Values ◽

Nerve Grafts ◽

The Mean ◽

The Difference ◽

Mean Time

Objective: The main objective of this study is to evaluate the availability of lateral antebrachial cutaneous nerve (LACN) autograft for acute or delayed repair of segmented digital nerve injuries. Patients and Methods: 13 digital nerve defects of 11 patients; treated with interposition of LACN graft that harvested from ipsilateral extremity were included in the study. Mean follow up period was 35, 7 months. The mean time from injury to grafting is 53, 3 days. The results of the mean 2PDT and SWMT values of injured /uninjured finger at the end of follow up period were evaluated with Paired T test. The correlation between the defect length and the difference of 2PDT, SWMT values between the uninjured and injured finger at the end of follow up period; were evaluated with Pearson - correlation analysis. Results: The mean value of our 2PDT and SWMT results are ~5,923, ~3, 52, respectively in which can be interpreted between the normal and diminished light touch. The defect length and difference percentage of SWMT values is positively and significantly correlated statistically. Mean length of interposed nerve grafts was 18.5 mm. The age of the patient and the mean values of 2PDT and SWMT with the difference % of 2PDT and % of SWMT are not statistically correlated. Conclusion: Based on results regarding sensory regaining at recipient side and negligible sensory deficit at harvesting side, we suggest that lateral antebrachial cutaneous nerve might be a valuable graft option for digital nerve defects.

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O26 QUALITY OF LIFE FOR ACHALASIA PATIENTS IS THE SAME AFTER PER-ORAL ENDOSCOPIC MYOTOMY (POEM) AND HELLER MYOTOMY

Diseases of the Esophagus ◽

10.1093/dote/doz092.26 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Vrakopoulou Gavriella Zoi ◽

Di Maggio Francesco ◽

Barbieri Lavinia ◽

Zeki Sebastian ◽

Dunn Jason M ◽

...

Keyword(s):

Repeated Measurements ◽

Similar Degree ◽

Complication Rates ◽

Mean Values ◽

Per Oral Endoscopic Myotomy ◽

Eckardt Score ◽

Significant Difference ◽

Endoscopic Myotomy ◽

Per Oral

Abstract Aim This study aimed to compare the efficacy and safety of LHM and POEM for esophageal achalasia. Background & Methods Laparoscopic Heller’s myotomy (LHM) has been the gold standard of treatment, however per-oral endoscopic myotomy (POEM) was recently established as a treatment option for achalasia. A prospective review was performed for all patients submitted to LHM or POEM in our institution from 10/2012 to 06/2018, and have completed a minimum follow up period of 6 months. The diagnostic work-up included gastroscopy, barium study and high-resolution manometry (HRM). All patients underwent a clinical evaluation 6 weeks after treatment and a surveillance gastroscopy in the 1st postoperative year. HRM and pH studies were offered to all patients after 6 months. Standardized questionnaires evaluating Eckardt, GERD and achalasia QoL (Urbach) scores were completed pre- and postoperatively. Statistical analyses were performed with SPSS version 23.0. Repeated measurements analysis of variance was used to compare changes in mean values during follow up and between the two types of surgery. P values < 0.05 were considered significant. Results Eighty patients (34 women and 46 men) with mean age 42.6 years (16.2) underwent POEM (n=39) or LHM (n=41). QoL score was significantly improved in both study groups (p<0.001) with a similar degree of improvement (p=0.486). Eckardt scores showed a significant improvement in both groups, but repeated measurements analysis revealed a significant effect with time (p=0.038) with a greater improvement in POEM group. Moreover, Eckardt score change was similar between LHM and POEM patients without prior treatments (p=0.724), but in those with prior treatments the improvement trended higher in POEM group (p=0.087). GERD score had a similar and significant decrease in both groups (p=0.439), but in those with prior treatments the improvement was greater in LHM group (p=0.018). There was no significant difference regarding the complication rates for both groups (Clavien-Dindo I-IIIa). Conclusions POEM compares favorably with LHM as treatment for achalasia, as statistically significant improvement in QoL, GERD and Eckardt scores was recorded in both groups. In patients with prior treatments, POEM tends to achieve a greater improvement of Eckardt score and LHM a greater reduction regarding GERD score.

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Postarthroscopy Imaging in Femoroacetabular Impingement: Persistent Pain May Be Due to an Insufficient Correction of Preoperative Abnormalities

Joints ◽

10.1055/s-0037-1601411 ◽

2017 ◽

Vol 05 (01) ◽

pp. 021-026 ◽

Cited By ~ 1

Author(s):

Cosimo Tudisco ◽

Salvatore Bisicchia ◽

Sandro Tormenta ◽

Amedeo Taglieri ◽

Ezio Fanucci

Keyword(s):

Case Series ◽

Persistent Pain ◽

Retrospective Case ◽

Level Of Evidence ◽

Mean Values ◽

Center Edge ◽

Patient Groups ◽

The Mean ◽

Magnetic Resonance Imaging Mri

Purpose The purpose of this study was to evaluate the effect of correction of abnormal radiographic parameters on postoperative pain in a group of patients treated arthroscopically for femoracetabular impingement (FAI). Methods A retrospective study was performed on 23 patients affected by mixed-type FAI and treated arthroscopically. There were 11 males and 12 females with a mean age of 46.5 (range: 28–67) years. Center-edge (CE) and α angles were measured on preoperative and postoperative radiographic and magnetic resonance imaging (MRI) studies and were correlated with persistent pain at follow-up. Results The mean preoperative CE and α angles were 38.6 ± 5.2 and 67.3 ± 7.2 degrees, respectively. At follow-up, in the 17 pain-free patients, the mean pre- and postoperative CE angle were 38.1 ± 5.6 and 32.6 ± 4.8 degrees, respectively, whereas the mean pre- and postoperative α angles at MRI were 66.3 ± 7.9 and 47.9 ± 8.9 degrees, respectively. In six patients with persistent hip pain, the mean pre- and postoperative CE angles were 39.8 ± 3.6 and 35.8 ± 3.1 degrees, respectively, whereas the mean pre- and postoperative α angles were 70.0 ± 3.9 and 58.8 ± 2.6 degrees, respectively. Mean values of all the analyzed radiological parameters, except CE angle in patients with pain, improved significantly after surgery. On comparing patient groups, significantly lower postoperative α angles and lower CE angle were observed in patients without pain. Conclusion In case of persistent pain after arthroscopic treatment of FAI, a new set of imaging studies must be performed because pain may be related to an insufficient correction of preoperative radiographic abnormalities. Level of Evidence Level IV, retrospective case series.

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Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120959141 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095914

Author(s):

Justin C. Kennon ◽

Erick M. Marigi ◽

Chad E. Songy ◽

Chris Bernard ◽

Shawn W. O’Driscoll ◽

...

Keyword(s):

Clinical Outcomes ◽

Case Series ◽

Ulnar Collateral Ligament ◽

Ulnar Neuropathy ◽

Complication Rates ◽

Collateral Ligament ◽

Level Of Evidence ◽

Functional Scores ◽

The Mean

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

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Application of femtolaser-assisted phacoemulsification in combined pathology of cataract and glaucoma

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-2-18-21 ◽

2021 ◽

pp. 18-21

Author(s):

A.P. Voznyuk ◽

◽

S.I. Anisimov ◽

S.Y. Anisimova ◽

L.L. Arutyunyan ◽

...

Keyword(s):

Surgical Treatment ◽

Biomechanical Properties ◽

Mean Values ◽

Long Term Follow Up ◽

The Mean ◽

Group 2 ◽

Observation Period ◽

Group 1

Purpose. To evaluate the efficacy and safety of femtolaser-assisted phacoemulsification in glaucomatous eyes in the long-term follow-up. Materials and methods. A retrospective analysis of the results of the surgical treatment of patients with combined cataract and glaucoma pathology was analyzed. The patients were divided into groups depending on the method of surgical intervention: 1) phacoemulsification with femtolaser support (26 eyes, 23 patients); 2) phacoemulsification (36 eyes, 30 patients); Results. Before surgery, there were no statistically significant differences in IOP and corneal hysteresis (СН) between groups 1 and 2. The mean values of IOP cc, IOP g and СН of group 1 before surgery were 22.7±6.1 mm Hg, 20.9±6.9 mm Hg, 8.5±1.6 mm Hg; 2 group – 22.9±8.7 mm Hg, 21.6±8.9 mm Hg, 8.9±1.6 mm Hg respectively. Average values of IOP cc, IOP g and CН 5 years after the surgical treatment in group 1 were 15.3±1.2 mm Hg, 14.4±3.4 mm Hg, 9.6±4.2 mm Hg; in group 2 – 18.0±4.2 mm Hg, 16.1±4.2 mm Hg, 8.8±2.2 mm Hg respectively. In both groups, stabilization of IOP and CH indices was noted, which remained throughout the entire observation period, which shows the normalization of the biomechanical properties of the corneoscleral membrane of the eye in the long-term postoperative period. Conclusion. Femtolaser accompaniment of phacoemulsification is an effective and safe method of cataract surgery for combined pathology. Key words: femtolaser, cataract, glaucoma, phacoemulsification.

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Arthrocentesis and Sodium Hyaluronate Infiltration in Temporomandibular Disorders Treatment. Clinical and MRI Evaluation

Journal of Functional Morphology and Kinesiology ◽

10.3390/jfmk5010018 ◽

2020 ◽

Vol 5 (1) ◽

pp. 18 ◽

Cited By ~ 1

Author(s):

Mario Santagata ◽

Roberto De Luca ◽

Giorgio Lo Giudice ◽

Antonio Troiano ◽

Giuseppe Lo Giudice ◽

...

Keyword(s):

Temporomandibular Joint ◽

Joint Damage ◽

Mouth Opening ◽

Sodium Hyaluronate ◽

Mean Value ◽

Temporomandibular Joint Disorders ◽

Mean Values ◽

Masticatory Efficiency ◽

The Mean

Arthrocentesis in temporomandibular joint disorders can be associated with the intra-articular infiltration of various drugs with the objective of increase treatment efficacy. The aim of this study was to evaluate the clinical indexes variation in patients affected by temporomandibular joint disorders treated with arthrocentesis and sodium hyaluronate (SH) injections. A total of 28 patients suffering from temporomandibular joint disorders underwent one cycle of five arthrocentesis and infiltrations of sodium hyaluronate. Spontaneous mouth opening improved from 36.3 ± 7.5 mm to 45.1 ± 1.9 mm at six months follow-up. A significant reduction in the pain at rest and during mastication mean values emerged at follow-up (p < 0.0001). The mean masticatory efficiency, evaluated through a visual analogic scale, showed improvement at the follow-up period, highlighted by the increase of mean value from a baseline of 3.1 ± 1.2 to a mean value of 8.5 ± 1.2 (p < 0.0001). The mean severity of the joint damage at baseline time was 2.4 ± 0.9 and decreased to 0.4 ± 0.3 at the end of the follow-up period. The decrease in values is confirmed by statistical test (p < 0.05). Our data show how arthrocentesis integrated with sodium hyaluronate infiltrations performed under local anesthesia is a valid method of treating temporomandibular joint disorders.

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