WHAT IS THE BEST DISTAL LEVEL OF ARTHRODESIS IN LUMBAR FUSION IN PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS: L3 OR L4?

ABSTRACT Objective To evaluate coronal alignment in patients with idiopathic adolescent scoliosis with structured lumbar curves submitted to surgical treatment by comparing coronal alignment in the group fusion up to L3 and the group fusion up to L4. Methods Retrospective cohort study. We evaluated patients submitted to surgical treatment with arthrodesis of the lumbar curve with high density of screws with at least 6 months of follow-up. Radiographically, coronal alignment, shoulder height and functional outcome were analyzed through SRS30 questionnaire. Results A total of 25 patients were analyzed, of which 23 were female and 2 were male, with a mean age of 15.2 years (12 to 29 years) at the time of surgery. The patients were divided into two groups. Group A, n = 15: Distal level of fusion in L3 and Group B, n = 10: distal level of fusion in L4. There was no statistically significant difference between Groups A and B when compared to coronal alignment (balanced vs. unbalanced). However, when compared with the coronal alignment (CA) values, lower values of CA were observed in Group A, with statistical significance. No difference was observed between Groups A and B with respect to the SRS30 questionnaire. Conclusions Patients with idiopathic adolescent scoliosis submitted to arthrodesis of the lumbar curve have a better coronal alignment when the distal fusion level is L3. Level of evidence III; Comparative Retrospective Study (based on prospectively collected data).

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Comparison of Shape Memory Staple and Gelled Platelet-Rich Plasma versus Shape Memory Staple alone for the Treatment of Waist Scaphoid Nonunion: A Single-Center Experience

Joints ◽

10.1055/s-0040-1710387 ◽

2020 ◽

Author(s):

Rocco De Vitis ◽

Marco Passiatore ◽

Andrea Perna ◽

Giulio Fioravanti Cinci ◽

Giuseppe Taccardo

Keyword(s):

Surgical Treatment ◽

Shape Memory ◽

Platelet Rich Plasma ◽

Level Of Evidence ◽

Single Center Experience ◽

Upper Limb Function ◽

Mayo Wrist Score ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Purpose The aim of this study was to analyze the results of two different methods of surgical treatment of waist scaphoid nonunions (SNUs). We retrospectively analyzed data from 87 patients referred to our department from January 2010 to December 2017 who were surgically treated for waist SNU. Methods The mean period of time passed from trauma was 11.2 (±5.6) months. Patients were divided into two groups based on surgical treatment received: volar exposure osteosynthesis with shape memory staple (SMS) (group A) and volar exposure osteosynthesis with SMS and gelled platelet-rich plasma (GPRP) application at the bone defect level (group B). A cast (thumb excluded) was maintained for 4 weeks. Healing was checked clinically (pain, QuickDASH [Disabilities of the Arm, Shoulder, and Hand] score, Mayo Wrist Score) and radiologically (standard X-ray). Results Union was achieved in 40 patients in group A (95.2%) and in all patients in group B (45 patients; 100%). A statistically significant difference was observed in the improvement of the Mayo Wrist Score, QuickDASH score, and pain (measured through the visual analog scale) after 3 months from surgery (p = 0.02). Conclusion SMS is effective in treating waist SNU at more than 6 months from trauma. GPRP application can improve bone healing and upper limb function. Level of Evidence This is a retrospective observational Level III study.

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P-B02 Does the length of alimentary limb make a significant difference in the weight loss in Roux en y gastric bypass patients?

British Journal of Surgery ◽

10.1093/bjs/znab430.001 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Mayank Bhandari ◽

Sabyasachi Chowdhary ◽

Milind Rao ◽

Gopinath Bussa ◽

Julie Holm

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Statistical Significance ◽

Limb Length ◽

Alimentary Limb ◽

Significant Difference ◽

Alimentary Limb Length ◽

Biliopancreatic Limb ◽

Group A ◽

Group B

Abstract Background Roux en Y gastric bypass (RYGB) surgery for morbid obesity is considered as gold standard, but there can be a difference in the length of alimentary and biliopancreatic limb to achieve optimum weight loss. Till now there is no agreed consensus on the ideal limb lengths and their effect on the weight loss. We would like to evaluate the change in the alimentary limb length on the weight loss after the gastric bypass surgery, as a short to medium term single center study. Methods A retrospective analysis from prospectively maintained database of 523 patients who underwent RYGB from 2012 till 2018 was done. Patient who had at least a follow up of 2 years(n = 388) were included. At our center we use alimentary limb of 120 +/- 10 cm for Body Mass Index (BMI) < 40 kg/m2 (group A) and 150+/-10 cm for the BMI >40 kg/m2 (Group B). The biliopancreatic limb length varies from 50 to 70 cm and this does not change with BMI. The percentage excess weight(EWL) loss was measured and analyzed at 1st and 2nd year post operatively. We used paired t test to check for statistical significance. Results There were 172 patients in Group A and 216 in Group B. The number of females were 330 and males were 58. The average age was 44 years . The mean preoperative BMI for the 120 cm limb group was 37.1 kg/m2 and that for 150 cm limb was 45.3kg/m2. The EWL for the group A at 1 year and 2 year post op was a Mean and standard deviation of 79.3% +/- 39.4% and 78.3% +/- 35.2% respectively and for group B was 58.8% +/- 26.6% and 58.6% +/- 23.2% respectively. The difference was statistically significant (p < 0.001) . The analysis and interpretation for metabolic syndrome is yet to be determined. Conclusions In our study, Increasing the alimentary limb length for higher BMI reduced EWL. This is consistent with few other publications regarding the same. This has resulted in a change in our practice namely keeping the length of alimentary limb constant and varying the BP limb length. We will be analyzing and presenting this data in future.

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Sports Hernia in National Hockey League Players

The American Journal of Sports Medicine ◽

10.1177/0363546512462679 ◽

2012 ◽

Vol 41 (1) ◽

pp. 107-110 ◽

Cited By ~ 30

Author(s):

Andre Jakoi ◽

Craig O’Neill ◽

Christopher Damsgaard ◽

Keith Fehring ◽

James Tom

Keyword(s):

Statistical Significance ◽

Return To Play ◽

National Hockey League ◽

Control Group ◽

Sports Hernia ◽

Level Of Evidence ◽

Athletic Pubalgia ◽

Hockey Players ◽

Group A ◽

Group B

Background: Athletic pubalgia is a complex injury that results in loss of play in competitive athletes, especially hockey players. The number of reported sports hernias has been increasing, and the importance of their management is vital. There are no studies reporting whether athletes can return to play at preinjury levels. Purpose: The focus of this study was to evaluate the productivity of professional hockey players before an established athletic pubalgia diagnosis contrasted with the productivity after sports hernia repair. Study Design: Cohort study; Level of evidence, 3. Methods: Professional National Hockey League (NHL) players who were reported to have a sports hernia and who underwent surgery from 2001 to 2008 were identified. Statistics were gathered on the players’ previous 2 full seasons and compared with the statistics 2 full seasons after surgery. Data concerning games played, goals, average time on ice, time of productivity, and assists were gathered. Players were divided into 3 groups: group A incorporated all players, group B were players with 6 or fewer seasons of play, and group C consisted of players with 7 or more seasons of play. A control group was chosen to compare player deterioration or improvement over a career; each player selected for the study had a corresponding control player with the same tenure in his career and position during the same years. Results: Forty-three hockey players were identified to have had sports hernia repairs from 2001 to 2008; ultimately, 80% would return to play 2 or more full seasons. Group A had statistically significant decreases in games played, goals scored, and assists. Versus the control group, the decreases in games played and assists were supported. Statistical analysis showed significant decreases in games played, goals scored, assists, and average time on ice the following 2 seasons in group C, which was also seen in comparison with the control group. Group B (16 players) showed only statistical significance in games played versus the control group. Conclusion: Players who undergo sports hernia surgeries return to play and often perform similar to their presurgery level. Players with over 7 full seasons return but with significant decreases in their overall performance levels. Less veteran players were able to return to play without any statistical decrease in performance and are likely the best candidates for repair once incurring injury.

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Prepectoral Direct-to-Implant Breast Reconstruction: Early Outcomes and Analysis of Postoperative Pain

Aesthetic Surgery Journal Open Forum ◽

10.1093/asjof/ojz006 ◽

2019 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Rafi Fredman ◽

Cindy Wu ◽

Mihaela Rapolti ◽

Daniel Luckett ◽

Jason Fine ◽

...

Keyword(s):

Postoperative Pain ◽

Breast Reconstruction ◽

Statistical Significance ◽

Complication Rates ◽

Level Of Evidence ◽

Trade Offs ◽

Technological Advances ◽

Significant Difference ◽

Aesthetic Results ◽

Postmastectomy Radiation Therapy

Abstract Background Direct-to-implant (DTI) breast reconstruction provides high-quality aesthetic results in appropriate candidates. Most commonly, implants are placed in the subpectoral space which can lead to pain and breast animation. Surgical and technological advances have allowed for successful prepectoral implant placement which may eliminate these trade-offs. Objectives Here we present early outcomes from 153 reconstructions in 94 patients who underwent prepectoral DTI. We sought to determine whether these patients have less postoperative pain and narcotic use than subpectoral implant or expander placement. Methods A retrospective review was performed for all prepectoral DTI reconstructions at our institution from 2015 to 2016. Data were collected on postoperative pain and narcotic use while in hospital. Results The average follow-up time was 8.5 months (range, 3–17 months) and the overall complication rate was 27% (n = 41) with the most common complications being skin necrosis (9%, n = 13) and infection (7%, n = 11). No statistically significant difference in complications was found in patients who underwent postmastectomy radiation therapy. Patients who underwent prepectoral DTI reconstruction did not have a statistically significant difference in postoperative pain and narcotic use while in-hospital compared with other techniques. Conclusion Prepectoral DTI reconstruction provides good results with similar complication rates to subpectoral techniques. Prepectoral DTI eliminates the problem of breast animation. Although our series did not reach statistical significance in pain scores or requirement for postoperative narcotics, we believe that it is an important preliminary result and with larger numbers we anticipate a more definitive conclusion. Level of Evidence: 4

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Embryo sHLA-G secretion is related to pregnancy rate

Zygote ◽

10.1017/s0967199419000054 ◽

2019 ◽

Vol 27 (02) ◽

pp. 78-81

Author(s):

R. Rodríguez Díaz ◽

R. Blanes Zamora ◽

R. Vaca Sánchez ◽

J. González Pérez ◽

J.C. Alberto Bethencourt

Keyword(s):

Pregnancy Rate ◽

Culture Medium ◽

Embryo Quality ◽

Statistical Significance ◽

Preimplantation Embryos ◽

Enzyme Linked Immunosorbent Assay ◽

Significant Difference ◽

Invasive Method ◽

Group A

SummaryHLA-G expression has been detected in early preimplantation embryos and it has been postulated that a relationship between embryonic expression of this factor and successful pregnancy may exist. Forty-six patients were prospectively selected from our centre ‘Unidad de Reproducción Humana, Hospital Universitario de Canarias’ for conducting this study. In all cases, metaphase II (MII) oocytes were fertilized using intracytoplasmic sperm injection 2–4 h after retrieval. Embryos were cultured individually in 20 µl droplets of G-1 medium (VitroLife) under oil at 37°C and a 6% CO2environment. Fertilization was assessed at 18 h postinsemination and all oocytes fertilized were passed into a new culture plaque individually in 300 µl culture medium until day 3 of culture. The culture medium was examined for the expression and secretion of sHLA-G with a sandwich enzyme-linked immunosorbent assay kit (BioVendor, Heidelberg, Germany) according to the manufacturer’s instructions. We found statistical significance between higher levels of sHLA-G secretion and pregnancy rate. When both groups were compared there was no difference in embryo quality of transferred embryos, but a significant difference in the number of oocytes and the embryo quality of the cohort existed that was greater in the pregnant group. A standardized sHLA-G assay with a specifically defined range and standard units provides a non-invasive method to identify the most competent embryos for transfer.

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Calcium dobesilate and oxerutin: effectiveness of combination therapy

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2009.008085 ◽

2010 ◽

Vol 25 (2) ◽

pp. 66-71 ◽

Cited By ~ 11

Author(s):

B Akbulut

Keyword(s):

Combination Therapy ◽

Venous Insufficiency ◽

Statistical Significance ◽

Symptomatic Relief ◽

Antioxidant Properties ◽

Erythrocyte Aggregation ◽

Calcium Dobesilate ◽

Significant Difference ◽

Group A ◽

Group B

Objectives Chronic venous insufficiency (CVI) is an important cause of discomfort and inability to work. Hydroxyethylrutosides (Venoruton®; 0-[beta-hydroxyethyl]-rutosides) has been used for decades for the treatment of CVI. Studies have reported symptomatic relief and a decreased capillary filtration after the administration of the oral preparations. Calcium dobesilate is a synthetic venoactive drug acting on several levels. It inhibits capillary permeability; it has antioxidant properties; and it inhibits the synthesis of prostaglandins and thromboxanes, reducing platelet and erythrocyte aggregation, as well as blood viscosity. The aim of this study is to determine whether the combination of both drugs is more effective in decreasing patients' complaints. Methods One hundred and fifty patients with primary venous insufficiency were randomized into three groups: Group A receiving calcium dobesilate only, Group B receiving oxerutin only and Group C receiving both calcium dobesilate and oxerutin. Patients were evaluated with a questionnaire before and four weeks after treatment regarding following parameters: itching, fatigue, heaviness, numbness, cramp, swelling and sensitiveness. Patients rated their symptoms from 0 to 4 (0: absent; 1: mild; 2: moderate; 3: severe; 4: very severe). Results Complaints, which were scored by patients before and after treatment, decreased. Among the single-drug groups, itching score decreased more in Group B, whereas scores of fatigue, heaviness, numbness, cramp and swelling decreased more in Group A. But the difference was not significant, statistically. But all complaints decreased significantly in Group C. Difference of scores after treatment revealed no statistical significance in Group A and B, but scores of Group C produced a significant difference when compared with Group A and B. Conclusion Results demonstrate that a combination of calcium dobesilate and oxerutin shows a better improvement of complaints. These observations have to be confirmed in larger series with objective tests. Changes of quality of life after a combination therapy might also be of interest.

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Comparative Evaluation of the Embrasure Wire versus Arch Bar Maxillomandibular Fixation in the Management of Mandibular Fractures: Are Arch Bars Replaceable?

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0037-1603453 ◽

2018 ◽

Vol 11 (2) ◽

pp. 118-123

Author(s):

Sanjay Rastogi ◽

Tousif Ahmed ◽

Kolli Giri ◽

Ramakant Dandriyal ◽

Indra B. Niranjana Prasad ◽

...

Keyword(s):

Statistical Significance ◽

Demographic Data ◽

Study Data ◽

Mandibular Fractures ◽

Intermaxillary Fixation ◽

Maxillomandibular Fixation ◽

Arch Bar ◽

Significant Difference ◽

Group A ◽

Group B

The aim of this prospective study was to appraise the role of embrasure wiring in the treatment of mandibular fractures over the arch bar as adjunctive techniques of maxillomandibular fixation (MMF). This study was conducted on 40 patients who were surgically treated for mandibular fractures with accessory use of MMF (embrasure: group A vs. arch bars: group B). All patients were evaluated for demographic data, etiology, and location of fracture. Characteristically, the complications, including wire injury, infection, and malocclusion, were recorded. The data were analyzed using Student's t-test and chi-square test as appropriate. Statistical significance was set at p < 0.05). In this study, data from 40 patients were included. In group A (embrasure wiring), time required for placement of MMF was significantly less than (7.85 ± 0.81 minutes) that in group B, and also there was less incidence of wire prick to the operator in group A than in group B ( p < 0.05). However, in terms of wire prick and malocclusion, no statistically significant difference was noted in groups A and B ( p > 0.05). Patient treated with embrasure wiring intermaxillary fixation had better outcomes especially in terms of time of placement and less incidence of wire prick injury when compared with arch bar.

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Bilateral Neck Exploration May Not Reduce the Risk of Persistence but Shows a Perspective Advantage

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.520 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A256-A256

Author(s):

Dmitrii Buzanakov ◽

Ilya Sleptsov ◽

Arseny Semenov ◽

Roman Chernikov ◽

Konstantin Novokshonov ◽

...

Keyword(s):

Surgical Treatment ◽

Statistical Significance ◽

Bilateral Neck Exploration ◽

Neck Exploration ◽

True Rate ◽

Bilateral Exploration ◽

Blind Area ◽

Significant Difference ◽

Chi Squared ◽

History Of

Abstract There is still no consensus for an optimal surgical treatment of primary hyperpararthyroidism (PHPT). Virtually, most of the patients could be successfully treated with the selective parathyroidectomy (SPTE) based on preoperative visualization. However, this approach still has a “blind area” of undetected multiglandular disease (MGD). Bilateral neck exploration (BNE) may serve as a reasonable alternative but it meets the higher requirements for the surgical technique. A retrospective cohort study was conducted in order to reveal factors associated with the persistence of PHPT. 587 cases of PHPT patients who had received surgical treatment at SPSU Hospital in 2017–2018 were included. All the patients have at least one preoperative visualization study (neck ultrasound performed by a surgeon) before the operation. In 356 cases two studies were performed (additional 4D CT or MIBI scan) and 116 cases had all three. A surgeon was free to choose a type of the operation (selective or explorative) according to their strategic preferences. Bilateral neck exploration was performed in 160 cases. There was no difference in bilateral exploration rate (p = 0.3896) between the groups (with 1, 2 or 3 studies performed) indicating that the additional visualization does not allow to avoid bilateral exploration. MGD rate accounted for 7.4% (40 cases). It is important that any set of preoperative visualization modalities prove the absence of MGD reliably and select patients for SPTE precisely. Negative predictive value for different combinations of concordant studies (US+MIBI, US+CT and US+CT+MIBI) did not differ significantly and was 96.95%, 97.4% and 97.7% respectively. 26 cases of persistent disease were reported with no significant difference between BNE and SPTE groups. (6 vs 20 respectively, p = 0.792). A history of the thyroid or parathyroid operations was found to be the only factor predicting the higher risk of persistence (OR = 7.98; 95% CI [2.62 - 24.27]), while neither the number of parathyroid glands found during the surgery nor the number of preoperative visualization studies showed statistical significance. Only 47,5% cases of BNE was reported to have all four glands visualized. There rate of failure to found each gland was similar. Surprisingly, the superior parathyroid adenomas (P4) were more likely to be removed (chi-squared 10.378, p = 0.0006) but not in the cases with all four glands visualized intraoperatively (chi-squared 1.822, p = 0.0884). The true rate difference due to a hypothetical feature of parathyroid physiology seems to be not very likely. One may rather suggest than it is not an uncommon for a surgeon to identify a P3 gland as a P4 unless all for glands are visualized. This fact shows a perspective advanantage which may prevent some cases of persistence.

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Intra operative assessment of the coronal balance in spinal deformity surgery : a technical note and retrospective study

Acta Orthopaedica Belgica ◽

10.52628/87.1.22 ◽

2021 ◽

Vol 87 (1) ◽

pp. 175-179

Author(s):

Thibault Dewilde ◽

Sebastiaan Schelfaut ◽

Sven Bamps ◽

Matthias Papen ◽

Pierre Moens

Keyword(s):

Retrospective Study ◽

Case Series ◽

Technical Note ◽

Coronal Alignment ◽

Level Of Evidence ◽

Coronal Balance ◽

Scoliotic Deformity ◽

Significant Difference ◽

The Mean ◽

The Right

Obtaining a spine that is well balanced after fusion for scoliotic deformity is primordial for the patients’ quality of life. A simple T-shaped instrument combined with standard intraoperative fluoroscopy can be of great help to evaluate the coronal alignment quickly. The aim of this study was to evaluate if a T-shaped device could predict the postoperative coronal balance. Before finalization of the rod fixation, the balance was checked by verifying the relationship between the T-shaped instrument and the upper instrumented vertebra (UIV), and final adjustments were made to correct the coronal balance. A retrospective study was conducted on 48 patients who underwent surgery to correct scoliotic deformity. Intraoperative and postoperative coronal alignment was measured independently by two observers. The mean intraoperative horizontal offset measured between T-shaped instrument and the center of the UIV was 1,69mm to the right with a standard deviation (SD) of 12,43 mm. On postoperative full spine radiographs, the mean offset between the centra sacral vertical line and the center of the UIV was 2,44mm to the left with a SD of 13,10mm. There is no significant difference in coronal balance between both measurements (p=0,12). With this technique we were able to predict the postoperative coronal balance in all but one patient (97,92%). We conclude that the use of a simple T-shaped instrument can provide adequate intraoperative assessment of coronal balance in correcting scoliotic deformity. Level of evidence : IV – case series

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Comparison of Intralesional Meglumine Antimonite along withoral Itraconazole to Intralesional Meglumine Antimonitein the treatment of Cutaneous Leishmaniasis

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.6.363 ◽

2019 ◽

Vol 35 (6) ◽

Cited By ~ 1

Author(s):

Uzma Bashir ◽

Moizza Tahir ◽

Muhammad Irfan Anwar ◽

Faisal Manzoor

Keyword(s):

Cutaneous Leishmaniasis ◽

Clinical Cure ◽

Statistical Significance ◽

Military Hospital ◽

P Values ◽

Meglumine Antimoniate ◽

Significant Difference ◽

Group A ◽

Oral Itraconazole ◽

Group B

Background & Objective: Cutaneous leishmaniasis (CL) is endemic in developing countries like Pakistan. Pentavalent antimonials are still drug of choice, despite being toxic and intolerable for patients. Second line treatments have been extensively studied but the results of their efficacy are conflicting. This, to our knowledge, will be the first study in this regard. Our objective was to determine if combination of oral itraconazole with intralesional (IL) meglumine antimoniate (MA) reduces the duration of treatment for cutaneous leishmaniasis, as compared to intralesional MA alone. Methods: A randomized controlled trial (single blinded) was carried out from August 2017 till December 2017 on 69 patients who fulfilled inclusion criteria. They were assigned to Group-A or B by lottery method. Group-A patients received IL MA once a week while Group-B received oral itraconazole 200mg, once daily, for six weeks along with similar regimen of IL MA as Group-A. The patients were assessed every three weeks by the blinded assessor till clinical cure was achieved. A follow up visit, two months after clinical cure was done to look for relapse of the disease. Results: Thirty patients in Group-A and 35 patients in Group-B completed the study. At 3, 6, 9 and 12 weeks the patients were assessed for: no, partial or complete response and results of the two groups were compared for statistical significance. The p-values of 0.20, 0.57 and 0.11 at 3, 6 and 9 weeks, respectively, depict that there was no significant difference at any step of assessment between the two groups in terms of healing. The p values of each t test was >0.05 refuting the hypothesis. Conclusion: Combination of oral itraconazole with intralesional MA offered no benefit over intralesional MA alone in the management of cutaneous leishmaniasis in terms of duration of therapy. Abbreviations Used: IL = Intralesional, MA = Meglumine Antimoniate, LD = Leishmania Donovan, CL = Cutaneous leishmaniasis, CMH = Combined Military Hospital. doi: https://doi.org/10.12669/pjms.35.6.363 How to cite this:Bashir U, Tahir M, Anwar MI, Manzoor F. Comparison of Intralesional Meglumine Antimonite along with oral Itraconazole to Intralesional Meglumine Antimonite in the treatment of Cutaneous Leishmaniasis. Pak J Med Sci. 2019;35(6):1669-1673. doi: https://doi.org/10.12669/pjms.35.6.363 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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