Debridement and Corpectomy Via Single Posterior Approach to Treat Pyogenic Spondylitis after Vertebral Augmentation

2021 ◽  
Author(s):  
Shuai Zhang ◽  
Song Wang ◽  
Qing Wang ◽  
Jin Yang ◽  
Shuang Xu
Keyword(s):  
Severe Pain ◽  
Daily Activities ◽  
Neurological Deficits ◽  
Spinal Stability ◽  
Intraoperative Blood Loss ◽  
Surgical Time ◽  
Refractory Septic Shock ◽  
Single Posterior Approach ◽  
Efficacy Of Treatment ◽  
Effective Treatments

Abstract Background Infection after VA often limits the daily activities of patients and even threatens their life. Operation has become an indispensable choice for such patients. sPVRIF may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability. This study aimed to investigate the clinical efficacy of treatment of PSVA with sPVRIF. Methods The study was performed on 19 patients with PSVA who underwent VA at 4 hospitals in the region between January 2010 and July 2020. Nineteen patients were included. Among them, 16 patients underwent sPVRIF to treat the PSVA.Results A total of 2267 patients underwent VA at 4 hospitals in the region. Of the 19 patients with postoperative PSVA, suppurative spondylitis was misdiagnosed as an osteoporotic vertebral fracture in 4 patients and they underwent VA. Besides osteoporosis, 18 patients had other comorbidities.The average interval between the first surgery and the diagnosis of PSVA was 96.4 days. Of the 19 patients, 16 received surgical treatment.Among the patients undergoing surgery, one died of refractory septic shock after the surgery, and one died of prostate cancer. The surgical time was 175.0±16.8min, and the intraoperative blood loss was 465.6±166.0 mL.Fourteen patients recovered from the infection.Pathogenic microorganisms were cultured in 12 patients. Conclusion PSVA is an extremely serious complication that can even threaten the life of the patients.sPVRIF may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability.

scholarly journals Debridement and corpectomy via single posterior approach to treat pyogenic spondylitis after vertebral augmentation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shuai Zhang ◽  
Song Wang ◽  
Qing Wang ◽  
Jin Yang ◽  
Shuang Xu
Keyword(s):  
Severe Pain ◽  
Neurological Deficits ◽  
Spinal Stability ◽  
Vertebral Augmentation ◽  
Pathogenic Microorganisms ◽  
Surgical Time ◽  
Pyogenic Spondylitis ◽  
Single Posterior Approach ◽  
Posterior Debridement ◽  
Effective Treatments

Abstract Background Infection after vertebral augmentation (VA) often limits the daily activities of patients and even threatens their life. The operation may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability. This study aimed to investigate the clinical efficacy of the treatment of pyogenic spondylitis after vertebral augmentation (PSVA) with Single posterior debridement, vertebral body resection, and intervertebral bone graft fusion and internal fixation (sPVRIF). Methods The study was performed on 19 patients with PSVA who underwent VA at 4 hospitals in the region between January 2010 and July 2020. Nineteen patients were included. Among them, 16 patients underwent sPVRIF to treat the PSVA. Results A total of 2267 patients underwent VA at 4 hospitals in the region. Of the 19 patients with postoperative PSVA, suppurative spondylitis was misdiagnosed as an osteoporotic vertebral fracture(OVF) in 4 patients and they underwent VA. Besides osteoporosis, 18 patients had other comorbidities. The average interval between the first surgery and the diagnosis of PSVA was 96.4 days. Of the 19 patients, 16 received surgical treatment. The surgical time was 175.0±16.8 min, and the intraoperative blood loss was 465.6±166.0 mL. Pathogenic microorganisms were cultured in 12 patients. Conclusion PSVA is a severe complication that can even threaten the life of the patients. sPVRIF may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability.

scholarly journals Benefit of lag screw placement by a single- or two-screw nailing system in elderly patients with AO/OTA 31-A2 trochanteric fractures

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110037
Author(s):  
Fulong Zhao ◽  
Lijuan Guo ◽  
Xuefei Wang ◽  
Yakui Zhang
Keyword(s):  
Blood Loss ◽  
Elderly Patients ◽  
Fracture Healing ◽  
Healing Time ◽  
Harris Hip Score ◽  
Intraoperative Blood Loss ◽  
Trochanteric Fractures ◽  
Surgical Time ◽  
Gamma3 Nail ◽  
Intertan Nail

Objective To retrospectively analyze the clinical outcomes of two intramedullary fixation devices, the INTERTAN nail and Gamma3 nail, for treatment of AO/OTA 31-A2 trochanteric fractures in elderly patients. Methods In total, 165 elderly patients underwent treatment for AO/OTA 31-A2 trochanteric fractures in our hospital from June 2017 to June 2018 (INTERTAN group, n = 79; Gamma3 group, n = 86). All patients underwent radiological and clinical investigations and were followed up for an average of 12 months. Age, sex, fracture type, surgical time, intraoperative blood loss, fracture healing time, and complications were compared between the two groups. Results The surgical time was significantly shorter and the intraoperative blood loss volume was significantly lower in the Gamma3 than INTERTAN group (58.2 ± 2.5 vs. 81.7 ± 14.2 minutes and 170 ± 29 vs. 220 ± 16 mL, respectively). However, there were no significant differences in the reduction quality, hospital stay, fracture healing time, Harris hip score, postoperative complications, or 1-year postoperative mortality. Conclusion Both INTERTAN and Gamma3 nails may be effective for surgical treatment of AO/OTA 31-A2 trochanteric fractures in elderly patients. However, the Gamma3 nail was superior to the INTERTAN nail in terms of surgical time and intraoperative blood loss.

scholarly journals Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell’s disease

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shou-qian Dai ◽  
Rong-qing Qin ◽  
Xiu Shi ◽  
Hui-lin Yang
Keyword(s):  
Blood Loss ◽  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Cement Leakage ◽  
Intraoperative Blood Loss ◽  
Surgical Time ◽  
Significant Difference ◽  
Neurologically Intact ◽  
Operation Cost

Abstract Background Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell’s disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. Methods The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb’s angle were assessed by imaging. Results All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. Conclusion PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.

Frequency and nature of pain in patients undergoing neurorehabilitation

2020 ◽  
pp. 026921552095678
Author(s):  
Alicja Timm ◽  
Stefan Knecht ◽  
Matthias Florian ◽  
Heidrun Pickenbrock ◽  
Bettina Studer ◽  
...  
Keyword(s):  
Treatment Period ◽  
Daily Living ◽  
Severe Pain ◽  
Pain Medication ◽  
Daily Activities ◽  
Inpatient Stay ◽  
Moderate Pain ◽  
Group Level ◽  
Analog Scale ◽  
Pain Scores

Objective: This prospective study investigated the extent to which patients undergoing neurorehabilitation reported pain, how this pain developed during inpatient stay and whether patients were treated accordingly (using pain medication). Methods: The extent of pain, performance in daily activities, with a focus on possible impairment from pain, and pain medication were assessed at the beginning and the end of neurorehabilitation treatment. Overall 584 patients, with various neurological diagnoses, such as stroke, intracerebral hemorrhage, polyneuropathy, etc. were classified into four groups based on whether they reported having “no pain,” “mild pain,” “moderate pain,” or “severe pain.” All patients received conventional neurorehabilitation therapy in the Mauritius Hospital, Germany. Results: A total of 149 patients had clinically relevant pain at the beginning of their inpatient stay, at a group level this did not change significantly during the treatment period. At the end of inpatient stay, a slight increase was noted in patients reporting pain. Overall 164 patients suffered from moderate or severe pain, operationalized of pain scores >3 on the visual analog scale. A total of 145 patients who had pain at the end of inpatient stay, did not receive pain medication. There was a weak negative association between pain at baseline and activities of daily living at the end of the treatment period, such that, patients with higher pain levels tended to showed lower Barthel Index scores at the end. Conclusion: In our study, about one-third of patients suffered from clinically relevant pain during neurorehabilitation treatment and most of them did not receive any pain medication.

Comparison of 5 Surgical Techniques for Partial Liver Lobectomy in the Dog for Intraoperative Blood Loss and Surgical Time

2010 ◽  
Vol 39 (7) ◽  
pp. 856-862 ◽  
Author(s):  
Marije Risselada ◽  
Gary W. Ellison ◽  
Nicholas J. Bacon ◽  
Maximilian M.R. Polyak ◽  
Jim Van Gilder ◽  
...  
Keyword(s):  
Blood Loss ◽  
Surgical Techniques ◽  
Intraoperative Blood Loss ◽  
Surgical Time

Clinical benefit of liver hanging maneuver for right-side major hepatectomy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15171-15171
Author(s):  
H. Hayashi ◽  
T. Beppu ◽  
J. Nasu ◽  
T. Masuda ◽  
T. Mizumoto ◽  
...  
Keyword(s):  
Blood Loss ◽  
Liver Tumor ◽  
Tumor Size ◽  
Anterior Approach ◽  
Major Hepatectomy ◽  
Red Blood Cell Transfusion ◽  
Intraoperative Blood Loss ◽  
Liver Hanging Maneuver ◽  
Surgical Time ◽  
Hanging Maneuver

15171 Background: Liver hanging maneuver is a new technique in anterior approach of major hepatectomy. However, the impact of the maneuver has never been fully investigated in patients with liver tumors. To evaluate the surgical benefits of liver hanging maneuver, we set up a comparative study in right-side major hepatectomy. Methods: From 2000 to 2006, 326 hepatectomy were performed in our institution. Fifty-eight patients with liver tumor (hepatocellularcarcinoma in 36, metastatic liver tumor in 13, and the others in 9) considered for right-side major hepatectomy were prospectively analyzed. Right-side hepatectomy included 26 right hepatectomy, 24 extended right hepatectomy, and 8 tri-segmentectomy. The patients were devided into a group with conventional approach (n = 21), a group with anterior approach without hanging maneuver (n = 19), and a group with approach with liver hanging maneuver (n = 18). In the three groups, age, body mass index, child-pugh classification, type of liver tumor, staging in hepatocellularcarcinoma, tumor size, resected liver weights, intraoperative blood loss, frequency of transfusion and surgical time were analyzed. Results: In conventional approach, anterior approach without hanging maneuver, and approach with liver hanging maneuver, mean age was 55, 59, and 65 years, and mean tumor size was 65, 75, and 108mm, respectively. Patients with liver hanging maneuver were significantly elder (p<0.05) and have larger tumor size (p<0.01). There were no significant differences in body mass index, child-pugh classification, type of liver tumor, staging in hepatocellularcarcinoma, and resected liver weights. Mean intraoperative blood loss was 1771, 805, and 704g, and mean surgical time was 562, 483, and 435minutes, and the frequency of red blood cell transfusion was 33, 21, and 17%, respectively. Patients with liver hanging maneuver had significantly less intraoperative blood loss (P=0.0001) and surgical time (P=0.002). The frequency of red blood cell transfusion in the liver hanging maneuver group was significantly lower than that of the conventional group (p<0.05). Postoperative morbidity rate were 33.3, 15.8, and 16.7%, respectively. Conclusions: Liver hanging maneuver is less invasive and a quite useful method for right-side major hepatectomy. No significant financial relationships to disclose.

scholarly journals A novel electrosurgical divider: performance in a self-controlled tonsillectomy study

2021 ◽  
Author(s):  
Gerold Besser ◽  
Stefan Grasl ◽  
Elias L. Meyer ◽  
Julia Schnoell ◽  
Tina J. Bartosik ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Postoperative Bleeding ◽  
Neck Surgery ◽  
Controlled Clinical Trial ◽  
Intraoperative Blood Loss ◽  
Bleeding Events ◽  
Surgical Time ◽  
Secondary Bleeding ◽  
Temperature Controlled

Abstract Purpose Tonsillectomies are among the most common surgeries in otorhinolaryngology. A novel electrosurgical temperature-controlled instrument (device) promises rapid tonsillectomies and might reduce postoperative pain, but comparative studies to assess performance are warranted. Methods This randomized self-controlled clinical trial was conducted from October 2019 to October 2020 at the Department of Otorhinolaryngology, Head and Neck Surgery of the Medical University of Vienna. Forty-eight patients underwent a tonsillectomy with the device on one side and using cold-steel with localized bipolar cauterization on the other side (control). Main outcomes were the time for tonsil removal (per side) and the time to stop bleeding (per side). Secondary measurements were postoperative pain, assessed once on day 0 and five times on days 1, 3, 5, 7, and 10. Postoperative bleeding episodes and consequences were recorded. Results Device tonsillectomies were performed significantly faster than controls; the mean surgical time difference was 209 s (p < 0.001, 95% CI 129; 288). Intraoperative blood loss was significantly lower on the device side (all p < 0.05). Postoperative measurements of pain and bleeding were similar for both sides. Two return-to-theatre secondary bleeding events were recorded for the control side. Conclusion The novel electrosurgical temperature-controlled divider reduced the tonsillectomy surgical time and intraoperative blood loss, with no apparent negative effects on postoperative pain or bleeding, compared to a cold-steel tonsillectomy with localized bipolar cauterization. In time-restricted settings, the device could be beneficial, particularly after familiarization with device handling. Trial registration ClinicalTrials.gov Identifier: < Blinded for review > 

scholarly journals Comparison between the results of proximal femur nail anti-rotation and cemented bipolar hemiarthroplasty in treatment of intertrochanteric fractures in Sanglah Hospital in 2016

2019 ◽  
Vol 7 (9) ◽  
pp. 3475
Author(s):  
Wayan Suryanto Dusak ◽  
Herryanto Agustriadi Simanjuntak ◽  
I Gusti Ngurah Paramartha Wijaya Putra
Keyword(s):  
Blood Loss ◽  
Postoperative Complication ◽  
Harris Hip Score ◽  
Secondary Outcome ◽  
Surgical Trauma ◽  
Transfusion Rate ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Intraoperative Blood Loss ◽  
Surgical Time

Background: Hemiarthroplasty is now being considered as a primary treatment for comminuted unstable type of IT fracture in elderly on the grounds that it allows early mobilization and full weight bearing. Recently popular modality is fourth generation of intramedullary nails like the Proximal Femoral Nails. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure.Methods: A Forty patients, having Intertrochanteric fractures treated with PFNA or cemented BH at our institution between April 2016 and April 2017. The primary outcomes measures were postoperative complication and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, postoperative haemoglobin and hospital stay.Results: Seventeen patients in PFNA group and 23 patients in BH group were included for analysis. There were no significant differences between the two group regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between PFNA and BH group in comparison of intraoperative blood loss (p < 0.001), length of stay (p = 0.006), surgical time (p < 0.001), postoperative transfusion (p < 0.001), and decrease of hemoglobin (p=0.001).Conclusions: These findings indicate that PFNA has obvious advantages over the BH in treatment of intertrochanteric fractures in case of surgical trauma and postoperative complication.

scholarly journals Pain and Its Interference with Daily Activities in Medical Oncology Outpatients

2013 ◽  
Vol 4;16 (4;7) ◽  
pp. 379-389
Author(s):  
Nienke te Boveldt
Keyword(s):  
Pain Management ◽  
Pain Intensity ◽  
Severe Pain ◽  
Medical Oncology ◽  
Brief Pain Inventory ◽  
Daily Activities ◽  
Analgesic Treatment ◽  
Mild Pain ◽  
Pain Management Index ◽  
Pain Prevalence

Background: Pain prevalence at various stages of cancer ranges from 27% to 60% for outpatients. Yet, how pain is managed in this patient group is poorly understood. Objectives: The primary objective was to assess pain prevalence and intensity, and its interference with daily activities, in medical oncology outpatients. The secondary objectives were the adequacy of analgesic pain treatment and to identify independent predictors for moderate to severe pain. Study design: A cross-sectional study. Setting: Oncology outpatient clinics of 7 Dutch regional hospitals. Methods: Four hundred twenty-eight medical oncology outpatients were assigned to the study. Pain prevalence and interference of pain with daily activities were assessed using the Brief Pain Inventory. Adequacy of analgesic treatment was determined by calculating the Pain Management Index (PMI). Descriptive statistics, non-parametric tests, and logistic regression analysis were conducted. Results: More than one third of all participants reported pain (39%). Eighty-three patients (20%) had moderate to severe pain (NRS 5-10). Analgesic treatment was inadequate in more than half of the patients with pain (62%). Interference of pain with daily activities increased with increased intensity, yet even 10%-33% of patients suffering mild pain reported high interference with daily activities. High current pain intensity and high interference with general daily activities predicted moderate to severe pain. Limitations: No characteristics of nonparticipants were available. Conclusion: Pain remains a significant problem in medical oncology outpatients, and often pain is insufficiently managed. Patients with a high pain intensity were more at risk to experience pain related interference with daily activities, but even some patients suffering mild pain experienced this. As adequate pain relief for up to 86% of the patients with cancer should be feasible, pain in medical oncology outpatients is still undertreated. Taking into account the interference of pain with daily activities and predictors of pain will facilitate cancer pain management. The study has been approved by the Medical Ethics Committee (CMO) in all 7 hospitals (METC protocol number 2011/020) and has been registered by the Dutch Trial register (NTR): NTR2739. Key words: Pain, prevalence, cancer, interference with daily activities, pain management, Brief Pain Inventory, Pain Management Index, neuropathic pain

SIGNIFICANCE AND NEED OF TREATMENT OF PERIAPICAL LESION

INDIAN DRUGS ◽  
2014 ◽  
Vol 51 (07) ◽  
pp. 5-13
Author(s):  
S.R Pattan ◽  
◽  
P.S Bykod ◽  
P.U. Shetkar ◽  
S.V. Pattewar ◽  
...  
Keyword(s):  
Dental Caries ◽  
Infectious Diseases ◽  
Dental Pulp ◽  
Severe Pain ◽  
Tooth Loss ◽  
The Body ◽  
Periapical Lesion ◽  
Endodontic Disease ◽  
Periapical Inflammation ◽  
Effective Treatments

Dental caries, one of the most prevalent infectious diseases worldwide, affects approximately 80% of children and the majority of adults. Dental caries may result in endodontic disease, leading to dental pulp necrosis, periapical inflammation and bone desorption, severe pain, and tooth loss. Periapical inflammation may also increase inflammation in other parts of the body. Although many studies have attempted to develop therapies for this disease, there is still an urgent need for effective treatments.

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