A COMPARISON BETWEEN SYNTHETIC AND BIOSYNTHETIC MESHES IN THE SURGICAL TREATMENT OF SEVERE GENITAL PROLAPSE: RESULTS AND COMPLICATIONS

The effectiveness, tolerability and complications of two surgical procedures using prosthetic materials with different physical and structural properties were assessed with a full Urogynecology work-up, through a retrospective study of 158 patients with severe genital prolapse (POP-Q staging III-IV) selected from November 2006 to April 2009. Eighty-six patients underwent fascial replacement surgery with ProliftTM System with a dual transobturator access in the anterior district and a transperineal posterior access with a synthetic polypropylene type I mesh (Group A). Seventy-two patients who underwent pelvic organ prolapse surgery with Avaulta/Avaulta PlusTM System with a dual transobturator access in the anterior district and a dual transperineal posterior access with a biosynthetic polypropylene type I mesh coated with a film of hydrophilic porcine collagen were placed in Group B. There were no intra and postoperative complications. Results of mean 20.8 month follow-up showed an effective anatomical cure rate of 89.5% in group A and 86.1% in group B and a low percentage of erosive complications, 8.1% and 5.6% respectively. Validated questionnaires for prolapse, the UDI 6 s.f., the IIQ7 s.f. and the PISQ-12 all showed a statistically significant improvement of quality of life in patients undergoing the two procedures (Wilcoxon test: P<0.001).

Download Full-text

A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v1i1.3631 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Praveenkumar H. Bagali ◽

A. S. Prashanth

Keyword(s):

Medical Science ◽

Frozen Shoulder ◽

Signs And Symptoms ◽

Treatment Modalities ◽

Animal Kingdom ◽

Shoulder Joints ◽

Group A ◽

Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

Download Full-text

Influence of Ulnar Bow Sign on Surgical Treatment of Missed Bado Type I Monteggia Fracture in Children

10.21203/rs.3.rs-101496/v1 ◽

2020 ◽

Author(s):

Shijie Liao ◽

Tiantian Wang ◽

Qian Huang ◽

Yun Liu ◽

Rongbin Lu ◽

...

Keyword(s):

Surgical Treatment ◽

Radial Head ◽

Monteggia Fracture ◽

Type I ◽

Ulnar Osteotomy ◽

Group A ◽

The Mean ◽

Group B ◽

Stable Reduction

Abstract PurposeThe present study aimed to explore the influence of ulnar bow on the surgical treatment of Bado type I missed Monteggia fracture in children.MethodsThis study is a retrospective review of 24 patients between November 2010 and March 2019. All patients were treated with open reduction of the radial head and ulnar opening wedge osteotomy without annular ligament reconstruction. The mean interval between injury onset and surgery was five months (range: 2–12 months). The average age of participants at the time of surgery was 6.4 years (range: 3–10 years). We evaluated the maximum ulnar bow (MUB) and MUB position (P-MUB) via radiography. The patients were divided into middle group (group A: 14 cases, MUB located at 40% to 60% of the distal ulna) and distal group (group B: 10 cases, MUB located at 20% to 40% from the distal end of the ulna) based on P-MUB. The mean period of follow-up was 37 months (range: 6–102 months).ResultsAt the last follow-up, all the children showed stable reduction of the radial head, and the flexion function of elbow joint improved after operation (P<0.05). Group A presented a larger the ratio of maximum ulnar bow(R-MUB) and angle of ulnar osteotomy(OA) than group B (P<0.05). There was statistically significant difference between group A and Group B in the P-MUB (P < 0.05). The osteotomy angle was positively correlated with the R-MUB (R2 =0.497,P=0.013), The osteotomy angle was positively correlated with the P-MUB (R2=0.731,P=0.000), The R-MUB is proportional to the P-MUB (R2 =0.597,P=0.002). The regression equation of P-MUB and osteotomy angle: Angle=7.064+33.227* P-MUB (R2=0.459, P =0.000).ConclusionWhen the ulnar bow is positioned at the middle ulna, a stable reduction of radial head need to be achieved through a larger angle in the ulnar osteotomy. If the position of maximum ulnar bow (P-MUB) is closer to the middle of the ulna or the ratio of maximum ulnar bow (R-MUB) is larger, the osteotomy angle is larger.

Download Full-text

Efficacy of Endoscopic Posterior Nasal Neurectomy in Treating Eosinophilic Chronic Rhinosinusitis

ORL ◽

10.1159/000519724 ◽

2021 ◽

pp. 1-5

Author(s):

Manman Chen ◽

Ming Xu ◽

Xuefeng Lei ◽

Bin Zhang

Keyword(s):

Chronic Rhinosinusitis ◽

Surgical Recurrence ◽

Eosinophilic Chronic Rhinosinusitis ◽

Group A ◽

Sinonasal Outcome Test ◽

Random Number Table ◽

Group B

Objectives: Recent guidelines have revealed that eosinophilic chronic rhinosinusitis (ECRS) exhibits a strong tendency for recurrence after surgery and impairs quality of life. Neuropeptides play an important neuroimmunological role. The aim of this study was to determine the efficacy of posterior nasal neurectomy (PNN) for the treatment of ECRS by inhibiting type 2 cytokine expression. Methods: Forty-six patients were divided into group A and group B according to a random number table. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN, and group B underwent conventional FESS alone. The subjective and objective symptoms included a 10-cm visual analog scale (VAS), 22-item SinoNasal Outcome Test (SNOT-22) score, nasal speculum Lund-Kennedy score, and paranasal sinus computed tomography (CT) Lund-Mackay score at the 1-year postoperative follow-up. Results: Postoperative VAS (10.33 ± 2.18 vs. 8.38 ± 2.11, p < 0.01) and Lund-Kennedy score (1.95 ± 1.32 vs. 3.14 ± 1.35, p < 0.01) were significantly improved. The rhinorrhea score (1.76 ± 0.83 vs. 2.90 ± 1.14, p < 0.001) in the VAS and the discharge (0.43 ± 0.51, vs. 0.95 ± 0.67, p < 0.01) and edema (0.57 ± 0.60 vs. 0.95 ± 0.59, p < 0.05) scores in the Lund-Kennedy score were observed to have improved significantly in group A compared with those in group B. Conclusions: FESS combined with PNN suppresses edema symptoms, which might significantly decrease the surgical recurrence rate of ECRS in the long term.

Download Full-text

A concise infertility work-up results in fewer pregnancies

Human Reproduction Open ◽

10.1093/hropen/hoab033 ◽

2021 ◽

Vol 2021 (4) ◽

Cited By ~ 1

Author(s):

J A M Hamilton ◽

J W van der Steeg ◽

C J C M Hamilton ◽

J P de Bruin

Keyword(s):

Success Rate ◽

Pregnancy Rate ◽

Semen Analysis ◽

Prognostic Score ◽

Ongoing Pregnancy ◽

Ongoing Pregnancy Rate ◽

Group A ◽

Group B ◽

Work Up

Abstract STUDY QUESTION Is pregnancy success rate after a concise infertility work-up the same as pregnancy success rate after the traditional extensive infertility work-up? SUMMARY ANSWER The ongoing pregnancy rate within a follow-up of 1 year after a concise infertility work-up is significantly lower than the pregnancy success rate after the traditional and extensive infertility work-up. WHAT IS KNOWN ALREADY Based on cost-effectiveness studies, which have mainly focused on diagnosis, infertility work-up has become less comprehensive. Many centres have even adopted a one-stop approach to their infertility work-up. STUDY DESIGN, SIZE, DURATION We performed a historically controlled cohort study. In 2012 and 2013 all new infertile couples (n = 795) underwent an extensive infertility work-up (group A). In 2014 and 2015, all new infertile couples (n = 752) underwent a concise infertility work-up (group B). The follow-up period was 1 year for both groups. Complete follow-up was available for 99.0% of couples in group A and 97.5% in group B. PARTICIPANTS/MATERIALS, SETTING, METHODS The extensive infertility work-up consisted of history taking, a gynaecological ultrasound scan, semen analysis, ultrasonographic cycle monitoring, a timed postcoital test, a timed progesterone and chlamydia antibody titre. A hysterosalpingography (HSG) was advised routinely. The concise infertility work-up was mainly based on history taking, a gynaecological ultrasound scan and semen analysis. A HSG was only performed if tubal pathology was suspected or before the start of IUI. Laparoscopy and hormonal tests were only performed if indicated. Couples were treated according to the diagnosis with either expectant management (if the Hunault prognostic score was >30%), ovulation induction (in case of ovulation disorders), IUI in natural cycles (in case of cervical factor), IUI in stimulated cycles (if the Hunault prognostic score was <30%) or IVF/ICSI (in case of tubal factor, advanced female age, severe male factor and if other treatments remained unsuccessful). The primary outcomes were time to pregnancy and the ongoing pregnancy rates in both groups. The secondary outcomes were the number of investigations, the distribution of diagnoses made, the first treatment (started) after infertility work-up and the mode of conception. MAIN RESULTS AND THE ROLE OF CHANCE The descriptive data, such as age, duration of infertility, type of infertility and lifestyle habits, in both groups were comparable. In group A, more than twice the number of infertility investigations were performed, compared to group B. An HSG was made less frequently in group B (33% versus 42%) and at a later stage. A Kaplan–Meier curve shows a shorter time to pregnancy in group A. Also, a significantly higher overall ongoing pregnancy rate within a follow-up of 1 year was found in group A (58.7% versus 46.8%, respectively, P < 0.001). In group A, more couples conceived during the infertility work-up (14.7% versus 6.5%, respectively, P < 0.05). The diagnosis cervical infertility could only be made in group A (9.3%). The diagnosis unexplained infertility differed between groups, at 23.5% in group A and 32.2% in group B (P < 0.001). LIMITATIONS, REASONS FOR CAUTION This was a historically controlled cohort study; introduction of bias cannot be ruled out. The follow-up rate was similar in the two groups and therefore could not explain the differences in pregnancy rate. WIDER IMPLICATIONS OF THE FINDINGS Re-introduction of an extensive infertility work-up should be considered as it may lead to higher ongoing pregnancy rates within a year. The therapeutic effects of HSG and timing of intercourse may improve the fertility chance. This finding should be verified in a randomized controlled trial. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained for this study. No conflicts of interest were declared. TRIAL REGISTRATION NUMBER N/A.

Download Full-text

GCT-38. RELAPSE PATTERNS OF INTRACRANIAL GERMINOMAS BEFORE AND AFTER ENDOSCOPIC ERA

Neuro-Oncology ◽

10.1093/neuonc/noaa222.257 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii335-iii335

Author(s):

Takao Tsurubuchi ◽

Shingo Takano ◽

Ai Muroi ◽

Kei Hara ◽

Masahide Matsuda ◽

...

Keyword(s):

Third Ventricle ◽

Whole Brain Irradiation ◽

Brain Irradiation ◽

Before And After ◽

Group A ◽

Group B ◽

Neuroendoscopic Biopsy ◽

Relapse Patterns

Abstract PURPOSE We evaluated the relapse patterns of CNS germinomas before and after introducing neuroendoscopic biopsy in 2000. METHODS We retrospectively assessed the relapse patterns of 57 patients treated as pure germinoma or germinoma with STGC between 1980 and 2019 at University of Tsukuba, partially containing the patients of the previous report (Takano S et al., World Neurosurg, 2015). Median age was 15 y.o.(7y.o.~38y.o.), and men was 80.7%. Tumor locations were pineal 35, sellar 19, basal ganglia 3, others 11. Group A;1980~1999 was 20, and group B;2000~2019 was 37. From 1980 to 1994, whole brain irradiation(WB) 30.6 Gy plus whole ventricle irradiation(WV) 19.8 Gy. From 1995 to 1999, WV 26~30.6 Gy with Chemotherapy(Chem) or Chem alone. Since 2000, Chem for 3 kurr with WV 24~30.6 Gy, and 6–19.8 Gy as local boost to residual lesion. RESULTS Follow up periods were median 121 M(4.5M~386M; group A), and median 89 M(4 M~231 M; group B). Six patients(30%) recurred in the group A, as ex field 4(1;brain and extramedullary, 1;brain and paranasal sinus, 1;LV & third ventricle, 1;extramedullary), in field 1(LV). Chem only 1(LV & third ventricle). Two patients(5.4%) recurred in the group B, as ex field 2(1;intramedullary, 1;extramedullary). The group A showed CR;18, PR;1, Dead;1(Dissemination), and the group B showed CR;35, PR;1 Dead;1(Encephalopathy). CONCLUSION WV and Chem prevented extrafield recurrence keeping good quality of life. Neuroendscopy biopsy with ETV did not increase CSF seeding.

Download Full-text

The effectiveness of a robotic tilt table on the muscle strength and quality of life in individuals following stroke: a randomised control trial

International Journal of Therapy and Rehabilitation ◽

10.12968/ijtr.2019.0014 ◽

2020 ◽

Vol 27 (12) ◽

pp. 1-9

Author(s):

Suraj Kumar ◽

Ramakant Yadav ◽

Aafreen Afrin

Keyword(s):

Quality Of Life ◽

Muscle Strength ◽

Early Rehabilitation ◽

Randomised Control Trial ◽

Tilt Table ◽

Group A ◽

Conventional Physiotherapy ◽

Group B

Background/Aims Stroke is a common, serious and disabling condition. There is a need for early rehabilitation to cut the long-term ill effects of stroke and to maximise functional recovery. This study aimed to assess the effect of Erigo tilt table training on muscle strength and quality of life in individuals who have survived a stroke. Methods A total of 133 patients were recruited and randomly assigned to receive conventional physiotherapy (group A) or Erigo tilt table training (group B). Both groups underwent an intervention programme lasting 30 days. Quality of life and muscle strength were assessed at baseline (day 0), at the end of the intervention (day 30) and at follow up (day 90). Results Overall, 110 patients completed the study: 55 in group A and 55 in group B. Quality of life and muscle strength significantly improved between baseline and follow up with both interventions. Group A's quality of life and upper and lower muscle strength scores increased from 75, 0.57 and 1.0 at baseline to 89, 3.0 and 3.5 at follow up, respectively; while group B's scores increased from 75, 1.35 and 1.43 at baseline to 102, 3.0 and 3.64 at follow up. The Erigo tilt table resulted in significantly greater improvements than conventional physiotherapy (P<0.01). Conclusions The Erigo tilt-table could be valuable tool in the early rehabilitation of patients with acute hemiplegia as it improves muscle strength and quality of life to a greater extent than conventional physiotherapy.

Download Full-text

The Effect of Non-Personalised Tips on the Continued Use of Self-Monitoring mHealth Applications

Brain Sciences ◽

10.3390/brainsci10120924 ◽

2020 ◽

Vol 10 (12) ◽

pp. 924

Author(s):

Vishnu Unnikrishnan ◽

Miro Schleicher ◽

Yash Shah ◽

Noor Jamaludeen ◽

Ruediger Pryss ◽

...

Keyword(s):

Study Groups ◽

Self Monitoring ◽

Unseen Data ◽

Tinnitus Distress ◽

Group A ◽

Continued Use ◽

Group B ◽

Ecological Momentary

Chronic tinnitus, the perception of a phantom sound in the absence of corresponding stimulus, is a condition known to affect patients’ quality of life. Recent advances in mHealth have enabled patients to maintain a ‘disease journal’ of ecologically-valid momentary assessments, improving patients’ own awareness of their disease while also providing clinicians valuable data for research. In this study, we investigate the effect of non-personalised tips on patients’ perception of tinnitus, and on their continued use of the application. The data collected from the study involved three groups of patients that used the app for 16 weeks. Groups A & Y were exposed to feedback from the start of the study, while group B only received tips for the second half of the study. Groups A and Y were run by different supervisors and also differed in the number of hospital visits during the study. Users of Group A and B underwent assessment at baseline, mid-study, post-study and follow-up, while users of group Y were only assessed at baseline and post-study. It is seen that the users in group B use the app for longer, and also more often during the day. The answers of the users to the Ecological Momentary Assessments are seen to form clusters where the degree to which the tinnitus distress depends on tinnitus loudness varies. Additionally, cluster-level models were able to predict new unseen data with better accuracy than a single global model. This strengthens the argument that the discovered clusters really do reflect underlying patterns in disease expression.

Download Full-text

Bilateral Use of Iliac Branch Devices for Aortoiliac Aneurysms Is Safe and Feasible, and Procedural Volume Does Not Seem to Affect Technical or Clinical Effectiveness: Early and Midterm Results From the pELVIS International Multicentric Registry

Journal of Endovascular Therapy ◽

10.1177/15266028211016439 ◽

2021 ◽

pp. 152660282110164

Author(s):

Mario D’Oria ◽

Georgios A. Pitoulias ◽

Giovanni F. Torsello ◽

Apostolos G. Pitoulias ◽

Stefano Fazzini ◽

...

Keyword(s):

Study Groups ◽

Primary Patency ◽

Type I ◽

Mortality And Morbidity ◽

Procedural Volume ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact

Objective To evaluate early and follow-up outcomes following bilateral use of iliac branch devices (IBD) for aortoiliac endografting and assess the impact of center volume. We used data from the pELVIS international multicentric registry. Methods For the purpose of this study, only those patients receiving concomitant bilateral IBD implantation were analyzed. To assess the impact that procedural volume of bilateral IBD implantation could have on early and follow-up outcomes, participating institutions were classified as Site(s) A if they had performed >10 and/or >20% concomitant bilateral IBD procedure, otherwise they were classified as Site(s) B. Endpoints of the analysis included early (ie, 30-day) mortality and morbidity, as well as all-cause and aneurysm-related mortality during follow-up. Additional endpoints that were evaluated included IBD-related reinterventions, IBD occlusion or stenosis requiring reintervention (ie, loss of primary patency), and IBD-related type I endoleak. Results Overall, 96 patients received bilateral IBD implantation (out of 910 procedures collected in the whole pELVIS cohort), of whom 65 were treated at Site A (ie, Group A) and 31 were treated at Site(s) B (ie, Group B). In total, only 1 death occurred within 30 days from bilateral IBD implantation, and 9 patients experienced at least 1 major complication without any significant difference between subjects in Group A versus those in Group B (10.8% vs 6.5%, p=0.714). In the overall cohort, the 2-year freedom from IBD-related type I endoleaks and IBD primary patency were 96% and 92%, respectively; no significant differences were seen in those rates between Group A or Group B (95% vs 100%, p=0.335; 93% vs 88%, p=0.470). Freedom from any IBD-related reinterventions was 83% at 2 years, with similar rates between study groups (85% vs 83%, p=0.904). Conclusions Within the pELVIS registry, concomitant bilateral IBD implantation is a safe and feasible technique for management of aortoiliac aneurysms in patients with suitable anatomy. Despite increased technical complexity, effectiveness of the repair is satisfactory with low rates of IBD-related adverse events at mid-term follow-up. Procedural volume does not seem to affect technical or clinical outcomes after bilateral use of IBD, which remains a favorable treatment option in selected patients.

Download Full-text

Complete Fundus Mobilization Reduces Dysphagia After Nissen Procedure

Surgical Innovation ◽

10.1177/1553350620971174 ◽

2020 ◽

pp. 155335062097117

Author(s):

Adolfo Renzi ◽

Giandomenico Di Sarno ◽

Francesco d’Aniello ◽

Antonio Brillantino ◽

Gianluca Minieri ◽

...

Keyword(s):

Nissen Fundoplication ◽

Postoperative Dysphagia ◽

Great Caution ◽

Sf 36 ◽

Group A ◽

Laparoscopic Nissen ◽

Group B ◽

Structured Questionnaire

Background. Anti-reflux surgery is an effective treatment for gastroesophageal reflux disease (GERD). Nevertheless, surgery is still indicated with great caution in relation to the risk of complications, and in particular to postoperative dysphagia (PD). Objective. To compare the clinical outcomes, with particular focus on the incidence and severity of PD, of laparoscopic Nissen–Rossetti fundoplication (NRF) and floppy Nissen fundoplication (FNF) with complete fundus mobilization, in the surgical treatment of GERD. Methods. Ninety patients with GERD were enrolled. Forty-four patients (21[47.7%] men, 23[52.2%] women; mean age 42.4 ± 14.3 years) underwent NRF (Group A), and 46 patients (23[50%] men, 23[50%] women; mean age 43.3 ± 15.4 years) received laparoscopic FNF with complete fundus mobilization (Group B). Clinical assessment was performed using a structured questionnaire and SF-36 quality of life (QoL) score. PD was assessed using a validated classification, and an overall outcome was also determined by asking the patient to score it. Results. At 24-month follow-up, 38 (88.3%) patients in Group A vs 39 (86.6%) in Group B reported to be completely satisfied with reflux relief and free of protonic pump inhibitors (PPIs), while 3 (6.9%) in Group A vs 2(4.4%) in Group B reported occasional PPI intake and 2(4.6%) in Group A vs 4(8.8%) in Group B needed regular PPI use. Persistent PD was observed in 8(18.6%) patients in Group A and in 2(4.4%) in Group B ( P = .03). No significant differences were found in the QoL score and in the overall outcome perceived by the patients. Conclusion. FNF, with complete fundus mobilization, appears to be associated with a lower rate of postoperative persistent dysphagia.

Download Full-text

A CLINICAL STUDY ON MANAGEMENT OF POST-OPERATIVE PAIN AND QUALITY OF LIFE OF OSTEOARTHRITIS PATIENTS AFTER TOTAL KNEE ARTHROPLASTY

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i4.23768 ◽

2018 ◽

Vol 11 (4) ◽

pp. 93

Author(s):

Tamilslevan T ◽

Kalaivani H

Keyword(s):

Quality Of Life ◽

Pain Score ◽

Post Operative Pain ◽

Group A ◽

Total Knee ◽

Inflammatory Drugs ◽

Group B ◽

Pain Symptoms

Objective: The objective of this study is to assess the effect of pregabalin in the management of post-operative pain and the quality of life (QOL) of osteoarthritis (OA) patients after total knee arthroplasty.Methods: This prospective observational study was conducted in the Department of Orthopedics. A total of 96 patients were divided into two groups. Group A consists of 50 patients with the treatment of nonsteroidal anti-inflammatory drugs (NSAIDs) and Group B consists of 46 patients with the treatment of pregabalin with NSAIDs. The study subjects were followed once in 60 days for 6 months, and they were asked to answer the visual analog scale (VAS) and knee injury and OA outcome score (KOOS) questionnaire. The effect of the treatment was assessed by comparing the baseline score with follow-up score.Results: Our study result showed that the pain score of Group B in VAS at 2nd follow-up was 2.56±0.34 and KOOS pain score was 92.73±3.45 (p<0.01). The QOL score was improved significantly to 81.56±5.29 (p<0.01) as compared to Group A.Conclusion: The study concluded that pregabalin with NSAIDs group patients showed a better improvement in pain, symptoms, and QOL within short duration as compared to NSAIDs alone used group.

Download Full-text