THE USE OF CRANIAL HALO TRACTION VERSUS TEMPORARY INTERNAL DISTRACTION IN STAGED SURGERY FOR SEVERE SCOLIOSIS: A COMPARATIVE STUDY

2021 ◽  
Vol 20 (4) ◽  
pp. 254-259
Author(s):  
José Alberto Alves Oliveira ◽  
Antônio Cardoso Paiva ◽  
Pedro Paschoal Cassapis Cardoso Afonso ◽  
Paulo Cesar Almeida ◽  
Rogério dos Reis Visconti ◽  
...  
Keyword(s):  
Demographic Data ◽  
Level Of Evidence ◽  
Severe Scoliosis ◽  
Halo Traction ◽  
Definitive Surgery ◽  
Student’S T ◽  
Vertebral Resection ◽  
Internal Distraction ◽  
Student’S T Test

ABSTRACT Objective: To determine which method is more effective – cranial halo traction or temporary internal distraction – in staged surgeries for patients with severe (≥ 100°) and stiff (<25% flexibility) scoliosis. Methods: A sample of 12 patients with traction and 7 patients without traction, operated on between January 2013 and December 2017. The patients’ demographic data, the type of surgery performed, complications, and coronal and sagittal alignment parameters were recorded before surgery and in the final follow-up. The data were processed in SPSS 20.0. Comparisons were made between the means (Student's t-test) and the clinical and procedure-related characteristics (likelihood ratio and Fisher's Exact tests), at a confidence level of 0.05. Results: There were no significant intergroup differences for clinical characteristics, complications or degree of correction. However, more patients in the group submitted to temporary internal distraction required vertebral resection osteotomies during definitive surgery (p<0.05). Conclusions: Based on the results, it was not possible to establish which is the most effective method, but it is suggested that staged traction may be more effective, and safer, particularly when the surgeon is less experienced, during surgery on patients with severe and stiff scoliosis. Level of evidence IV; Vase series.

scholarly journals ‘Blood in pee’ campaign: Increased demand on secondary care with no change in cancers diagnosed

2018 ◽  
Vol 12 (1) ◽  
pp. 15-19
Author(s):  
Kunjan Patel ◽  
Susan Jane Hall ◽  
Kamath Shraddha ◽  
Richard Stanford ◽  
Simon Williams ◽  
...  
Keyword(s):  
Cancer Awareness ◽  
Level Of Evidence ◽  
Awareness Campaigns ◽  
Economic Background ◽  
Kolmogorov Smirnov ◽  
The Mean ◽  
Student’S T ◽  
The Impact ◽  
Index Of Multiple Deprivation ◽  
Student’S T Test

Objective: As part of the national Be Clear on Cancer campaign, the ‘blood in pee’ campaign was launched in 2013. We aimed to evaluate the impact of the campaign on 2-week wait (2WW) referrals and the resulting diagnoses of malignancy at a single trust, and secondly, to evaluate the socio-economic background of patients referred. Patients and methods: Suspected cancer 2WW patients in the 3 months pre- and post-campaign were included. Demographics, investigations and diagnoses were recorded. A Kolmogorov–Smirnov test demonstrated a normal distribution. The data were treated as parametric and analysed with the unpaired Student’s t-test. Results: Referrals for visible haematuria significantly increased by 52% from 135 pre-campaign to 205 post-campaign ( p = 0.03). There was a fall in the proportion of patients diagnosed with malignancy from 20.27% pre-campaign to 15.36% post-campaign. The mean index of multiple deprivation score of referrals did not change: p = 0.43. Conclusion: This campaign has increased referrals without increasing the proportion of malignancies diagnosed, placing large demand on services without benefit or extra funding. Nor has the campaign effectively reached deprived socio-economic groups. There is little evidence as to the efficacy of untargeted cancer awareness campaigns and further work is needed to improve their pick-up of malignancies. Level of evidence: 2C

scholarly journals Use of tranexamic acid in total knee arthroplasty

Joints ◽  
2016 ◽  
Vol 04 (04) ◽  
pp. 202-213 ◽  
Author(s):  
Francesco Marra ◽  
Federica Rosso ◽  
Matteo Bruzzone ◽  
Davide Bonasia ◽  
Federico Dettoni ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Demographic Data ◽  
Level Of Evidence ◽  
Total Blood ◽  
Prospective Comparative Study ◽  
Total Knee ◽  
Student’S T

Purpose: different strategies have been developed to reduce blood loss in total knee arthroplasty (TKA). The efficacy of both systemic and local tranexamic acid (TXA) administration is demonstrated in the literature. The aim of the present study was to compare the efficacy of systemic, local and combined (systemic + local) administration of TXA in reducing blood loss after TKA. Methods: we enrolled all patients submitted to a primary TKA in our department between November 2014 and August 2015. They were divided into three groups corresponding to the method of TXA administration used: intravenous (IV), intra-articular (IA), and a combination of the two. Demographic data, as well as preoperative hemoglobin and platelet levels, were collected. The primary outcome was the maximum hemoglobin loss, while the secondary outcomes were the amount of blood in the drain (cc/hour) and the rate of transfusions; postoperative pain was also assessed. Student’s t-test or a χ2 test was used to evaluate between-group differences, using p<0.05 as the cut-off for statistically significant differences. Results: the sample comprised 34 patients: IV, 10 cases; IA, 15 cases, and combined (IV + IA), 9 cases. The average age of the patients was 71.1±6.4 years. No significant differences in the outcome measures were found between the groups, with the exception of a significantly lower maximum hemoglobin loss in the combined versus the IV group (p=0.02). There were no differences between the groups in the amount of blood in the drain or the rate of transfusions. Conclusions: the data from this preliminary study, as well as data from the literature, confirm that TXA administration is safe and effective in reducing total blood loss in TKA, and no administration protocol seems to be superior to the others. Level of evidence: Level II, prospective comparative study.

Correction of Swan Neck Deformity in Rheumatoid Arthritis Using a New Lateral Extensor Band Technique

2008 ◽  
Vol 33 (6) ◽  
pp. 712-716 ◽  
Author(s):  
M. SIROTAKOVA ◽  
A. FIGUS ◽  
P. JARRETT ◽  
A. MISHRA ◽  
D. ELLIOT
Keyword(s):  
Flexor Digitorum Superficialis ◽  
Palmar Plate ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Distally Based ◽  
Student’S T ◽  
Flexor Digitorum ◽  
Swan Neck Deformity ◽  
Student’S T Test

Swan neck deformity is a progressive and disabling condition that commonly affects rheumatoid arthritic hands. During a 4-year period, 101 fingers in 43 patients had this deformity corrected using a new procedure combining the distally based extensor lateral band technique described by Littler and the flexor digitorum superficialis (FDS)-palmar plate pulley introduced by Zancolli. The ranges of motion of the metacarpophalangeal, proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints were assessed pre-operatively and 12 months after surgery. An average PIP joint hyperextension of −13.3° was converted to +13.4°. The ranges of motion of the proximal and DIP joints were significantly different (Student’s t-test). No patient suffered recurrence of the deformity during an average follow-up of 20 months. This new technique improves some unappealing aspects of previous techniques and provides a stable and reliable correction of swan neck deformity.

scholarly journals T1 PELVIC ANGLE IN IMPROVEMENT OF PAIN IN HIGH-GRADE LUMBAR SPONDYLOLISTHESIS

2020 ◽  
Vol 19 (2) ◽  
pp. 108-111
Author(s):  
JOSÉ ALBERTO ALVES OLIVEIRA ◽  
VINÍCIUS TAPIE GUERRA E SILVA ◽  
LUIZ EDUARDO PEREIRA COSTA ASSIS DE ALMEIDA ◽  
RICARDO DE SOUZA PORTES MEIRELES ◽  
GUILHERME DE REZENDE LOPES ◽  
...  
Keyword(s):  
Strong Correlation ◽  
Sagittal Alignment ◽  
Demographic Data ◽  
Case Series ◽  
Slip Angle ◽  
High Grade ◽  
Data Types ◽  
Level Of Evidence ◽  
Global Sagittal Alignment

ABSTRACT Objective To evaluate the correlation between global sagittal alignment variables and pain improvement after surgery for High-Grade Spondylolisthesis (HGS). Methods A sample with 20 patients with L5-S1 HGS, submitted to arthrodesis with instrumentation from 01/2004 to 12/2016. Patients’ demographic data, types of surgeries, complications, sagittal alignment parameters, and Visual Analog Scale (VAS) score (ranging from 0 to 4) were recorded before surgery and at the last follow-up. The data were processed in SPSS 22.0. The confidence level was 0.05. Results The majority of the sample were women, 17 (85%); age at surgery: 52.60 ± 17.15 years; mean follow-up: 3.58 ± 1.62 years; isthmic etiology, 16 (80%) and dysplastic, 4 (20%); Meyerding Grading 3: 12 (60%), Grading 4: 3 (15%) and Grading 5: 5 (25%); SDSG type 4: 6 (30%), type 5a: 3 (15%), 5b: 3 (15%), type 6: 7 (35%) and not classified 1 (5%); surgery: in situ fusion 3 (15%) and reduction 17 (85%); fusion levels: L3-S1: 1 (5%), L3-Iliac: 1 (5%), L4-S1: 1 (5%), L4-Iliac: 6 (30%) and L5-S1: 11 (55%). Comparing the pre- and postoperative parameters, a significant improvement (p <0.05) was seen in the VAS, T1 slope, T1 pelvic angle (TPA), slip angle, Dubousset’s lumbosacral angle and slip %. Evaluating the correlation between the variation in sagittal parameters and the improvement in VAS scale, it was found that the TPA showed a strong correlation (r = 0.709, p = 0.032). Conclusions the present study found a strong correlation between the improvement/reduction in TPA values and the reduction in pain intensity in the VAS. Level of evidence IV; Case Series.

Monitoring and Evaluation of Thyroid Function Tests, Serum Electrolytes and Creatinine Levels Before and After 131I Therapy

2020 ◽  
Vol 20 (3) ◽  
pp. 419-424
Author(s):  
Rubaida Mehmood ◽  
Muhammed S. Khan ◽  
Sajid Hussain ◽  
Akhlaque Ahmed ◽  
Farhatul-Ain Arshad ◽  
...  
Keyword(s):  
Monitoring And Evaluation ◽  
131I Therapy ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Serum Electrolytes ◽  
Before And After ◽  
Student’S T ◽  
Thyroid Profile ◽  
Student’S T Test

Background: Serum electrolytes, Creatinine, and thyroid profile play an important role in 131I treated patients of thyroid disorders. Objectives: To determine the effect of radioactive iodine (131I) on renal parameters, serum electrolytes and the correlation among TFT’S, creatinine, and chloride levels before and after I131 treatment in thyroid disorders. Methods: The study was performed on 55 patients of thyrotoxicosis with age ranging from 16-65 years (mean age= 41±14years and BMI=24.8±4.46). The significance of the differences between the results of 1st, 2nd, and 3rd-time serum analysis was assessed by paired Student's t-test. Association between parameters was assessed by Spearman correlation analysis. Results: 40 patients were taking Carbimazole, and 15 were directly recommended for I131 therapy. Strongly significant variations were observed for TFT’S (T3=0.012, T4 =0.017, and TSH=0. 001) during the follow-up treatment. Before taking I131 (Serum analyzed at 1st time), there observed negative correlation of T3(r=-.46, p=0. 002) and TSH (r=-0.31, p=0.02) with creatinine, and positive correlation of TSH(r=0.29,p=0.02) with chloride. BMI was negatively correlated with potassium(r=-0.30, p=0.02). At the 2nd time (after stopping the Carbimazole), no correlation results were observed. Two months after oral administration of 131I, creatinine, and chloride level was significantly increased (p=0.000), (P=0. 03) respectively, but had no correlation with TFT’S. Conclusion: Our findings suggest that patients with goiter (diffused or toxic) have association of TFT’S and BMI with serum electrolytes and creatinine, 131I therapy is also associated with the increase in creatinine and chloride levels of patients leading to kidney problems.

The management of quinsy—a prospective study

1992 ◽  
Vol 106 (11) ◽  
pp. 986-988 ◽  
Author(s):  
C. R. Chowdhury ◽  
M. C. M. Bricknell
Keyword(s):  
Prospective Study ◽  
Significant Saving ◽  
Incision And Drainage ◽  
The Social ◽  
Student’S T ◽  
A Prospective Study ◽  
Abscess Tonsillectomy ◽  
Lost To Follow Up ◽  
Student’S T Test

AbstractA prospective study for the treatment of quinsy was undertaken between January 1989 and September 1991. This was to determine whether abscess tonsillectomy reduces inpatient stay without increasing operative risk compared to incision and drainage combined with interval tonsillectomy. Fifty-three patients were entered into the study. Twenty-one had abscess tonsillectomy and 32 had incision and drainage. This study showed that there is a 95 per cent probability that abscess tonsillectomy reduces hospital stay by between 2.04 and 4.84 (Student's t test t = 5.01; df = 31, p<0.001) days compared to incision and drainage followed by interval tonsillectomy. This is a significant saving in time and resources. Abscess tonsillectomy reduces patients lost to follow-up, avoids the social inconvenience of a second admission, effectively relieves symptoms, treats a contralateral abscess and is the only method of treating children with a quinsy. We recommend abscess tonsillectomy should be performed for quinsy where expertise and facilities are available.

Survey of Amanita phalloides poisoning: clinical findings and follow-up evaluation

2007 ◽  
Vol 26 (12) ◽  
pp. 955-961 ◽  
Author(s):  
M Křenová ◽  
D Pelclová ◽  
T Navrátil
Keyword(s):  
Renal Damage ◽  
Solitary Kidney ◽  
Serum Levels ◽  
Clinical Findings ◽  
Amanita Phalloides ◽  
Information Centre ◽  
Prothrombin Index ◽  
Student’S T ◽  
Student’S T Test

The aim of our study was to evaluate the severity of hepatic and kidney damage with a focus on their reversibility, and to analyze the prognostic factors following Amanita phalloides poisoning based on calls made to the Czech Toxicological Information Centre. A variety of clinical and laboratory parameters were collected. Student’s t-test and Fisher’s test were used for statistical analysis. Amanita phalloides poisoning was verified in 34 cases (5 children, 29 adults). The following findings emerged: vomiting (76%), diarrhea (62%), hepatic failure (24%), and renal failure (11%). Two patients died on the fifth day after mushroom ingestion. In 18 patients, all serum levels normalized by the time of discharge; in 10 patients up to 7.3 months on average after discharge. Five patients did not comply with follow-up. Renal damage persisted in only one patient, 19 months after discharge. In conclusion, the interval to recovery from hepatic and renal damage by the time of discharge depended on a decrease in the prothrombin index and an increase in serum transaminase and bilirubin levels. Recovery was favorable in all subjects who survived the acute phase of poisoning, except in one patient with a solitary kidney.

scholarly journals Therapeutic effect of Raktamokshan in the management of gridhrasi with modified version of Shrunga (cupping)

2019 ◽  
Vol 7 (01) ◽  
Author(s):  
PRADNYA MARUTI JADHAV
Keyword(s):  
Therapeutic Effect ◽  
Gluteal Region ◽  
Daily Routine ◽  
Low Back ◽  
Before And After ◽  
Student’S T ◽  
Straight Leg Raise ◽  
Test Result ◽  
Student’S T Test

The incidence rate of Gridhrasi (sciatica) is quite significant as more than three-quarters of the world's population is affected by the disease. It is characterized by the onset of Ruja (pain), Toda (pricking), and Stambha (stiffness), initially in Sphika (gluteal region) and then radiating distally to Kati-Prishtha (low back), Janu (knee), Jangha (thigh) till Pada (feet). The patients suffering from Gridhrasi have restricted movements due to painful limb, affecting the daily routine activities. Aim: To study and evaluate the therapeutic effect of Raktamokshan in the management of Gridhrasi with the modified version of Shrunga. (cupping). Materials and Methods: The study was conducted on twenty patients who had reported for the treatment of Gridhrasi at an Ayurvedic hospital. Raktamokshana was done on Sphik (gluteal region) or Kati (low back) region with the help of 22 no.surgical blades and modified version of shrunga (cupping instrument)in four settings (0, 5th, 10th and 15th day). The sign and symptoms, namely Ruka, Toda, Stambha  were given scores depending on their severity. The patients were also assessed for straight-leg raise (SLR) test. Follow-up was done at an interval of 5 days for three times and the scores were noted down before and after treatment. The scores were analyzed using the Student's t-test. Result: Marked reduction in severity of mean scores of Ruja, Toda, Stambha was seen in the patients after the use of the modified version of shrunga (cupping instrument) for Raktamokshana, which was statistically significant. Conclusions: cupping is the simple and effective treatment (in adjunct to other treatment) for reducing Ruka, Toda, Stambha  in Gridhrasi.

scholarly journals SPONDYLODISCITIS INVESTIGATION AND THERAPEUTIC PROTOCOL: NEUROSURGERY SERVICE RESULTS

2019 ◽  
Vol 18 (2) ◽  
pp. 138-143
Author(s):  
Guilherme Finger ◽  
André Martins de Lima Cecchini ◽  
Ericson Sfreddo ◽  
Felipe Martins de Lima Cecchini ◽  
Luciano Werle Lunardi ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Level Of Evidence ◽  
Correct Treatment ◽  
Lumbar Level ◽  
Therapeutic Protocol ◽  
Therapeutic Results ◽  
Level I ◽  
Student’S T ◽  
Student’S T Test

ABSTRACT Objective: Spondylodiscitis is still a frequent pathology among neurosurgical services, and its correct treatment involves infectious, neurological and orthopedic goals. The authors describe the protocol and report the diagnostic and therapeutic results after its implementation. Methods: A prospective prognostic study (Level I) including patients with primary spondylodiscitis treated in the Neurosurgical Service of Cristo Redentor Hospital from January 2014 to March 2018. Demographic, spine, infectious and treatment-related variables were analyzed. The numerical variables are presented as mean and standard deviation or median and interquartile range (according to their parametricity), and are compared by the student's t-Test or Mann-Whitney U Test, respectively. Results: Thirty seven patients were included. The sexes were evenly distributed, with predominantly Caucasians, and a mean age of 56.89 ±15.33. Hypertension and type 2 diabetes were the most frequent comorbidities. Vertebral lumbar level was the most involved segment. Pathogens were identified in 34 cases (91%), with Staphylococcus aureus being the most prevalent, followed by Koch Bacilli. Inflammatory markers are higher in pyogenic infections at hospital admission, but lower at hospital discharge when compared to tuberculous discitis (p<0.01). Mean hospital stay was higher in the pyogenic group. Conclusion: The protocol described has a high diagnostic level of the pathogen, with cure of infection and satisfactory neurologic outcome in all cases. Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test.

scholarly journals STUDY DESIGN: CASE SERIES OF 19 PATIENTS OPERATED FOR SEVERE SCOLIOSIS AND DIASTEMATOMYELIA

2019 ◽  
Vol 18 (1) ◽  
pp. 64-69
Author(s):  
Mikhail Vitalievich Mikhaylovskiy ◽  
Jean Dubousset ◽  
Vjacheslav Victorovtch Novikov ◽  
Alexander Sergeevich Vasyura ◽  
Inga Gennadievna Udalova ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Series ◽  
Congenital Scoliosis ◽  
Neurological Complications ◽  
Level Of Evidence ◽  
Severe Scoliosis ◽  
Spinal Cord Malformation ◽  
Significant Correction

ABSTRACT Objective: Diastematomyelia is a rare congenital spine and spinal cord malformation in which the spinal cord is divided into two parts by the osseous or fibrous septum. The incidence of diastematomyelia in patients with the most severe forms of congenital scoliosis is much higher than its general incidence in the population. When performing surgeries to correct scoliotic deformities, the question arises regarding the choice of a strategy for managing the septum. An unambiguous answer to this question does not exist, since the disease is very rare and heterogeneous. The aim was to summarize the data on different surgical strategies for detecting diastematomyelia. Methods: Literature review and retrospective analysis of our own clinical data. Results: We present our own experience of treating 19 patients with diastematomyelia and severe congenital scoliosis. Posture disorder was corrected in all cases; the septum was removed in none of the cases. Significant correction was achieved for all patients, and no neurological complications were observed in the short- and long-term follow-up. Conclusions: Surgical nonremoval of the spur enables compensation to be achieved, without neurological complications either in the immediate postoperative period or in the long-term (more than 2 years) follow-up. Level of Evidence IV; Case seriesh.

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