SEVERE CERVICAL MYELOPATHY: APPROACHES AND POSTOPERATIVE EVALUATION

ABSTRACT Objectives: To evaluate and compare the clinical evolution of surgical approaches used in patients with severe cervical myelopathy. Methods: Retrospective observational study in which 19 patients with myelopathy who underwent surgery were evaluated. Neurological assessments using the Frankel scale were conducted both preoperatively and one year following surgery, and the modified Japanese Orthopedic Association (JOA), Nurick, and Visual Analog Scale for pain (VAS) questionnaires were applied 1 year after the surgical procedure. Results: 89% of the participants were male and the average age was 63.9 years. No patient had postoperative neurological worsening, 12 patients (63.16%) had mild pain, and seven (36.84%) had moderate pain. The group with degenerative disease showed neurological improvement after surgery and the exclusively anterior approach was used in 84% of the cases, the exclusively posterior approach in 10% of the cases, and the dual approach in 6% of the cases. Conclusion: Surgical treatment has good results for inhibiting the unfavorable natural evolution of myelopathy within 1 year following surgery and promotes neurological improvement in degenerative cases, making it possible to use the anterior access route in most cases. Level of evidence III; Retrospective Study.

Outcome of Extended Varicocelectomy in Case of High Grade Varicocele

Background Varicocele is defined as abnormal dilation and tourtousity of the internal spermatic veins within the pampiniform plexus. It is common among adolescents and may contribute significantly to the risk of subfertility in adulthood. Objective To evaluate the outcome of extended varicocelectomy in case of high grade varicocele. Patients and methods In all, 30 varicocele cases including 12 left sided and 18 bilateral, comprising 48 spermatic cord units with clinically palpable varicocele and affected semen analysis underwent extended varicocele ligation. Testicular delivery was done in all the cases and assessment of the gubernacular veins was reported. The patients underwent clinical evaluation, scrotal doppler ultrasonography, as well as semen analysis to detect varicocele recurrence, hydrocele formation and early changes in semen parameters. The postoperative evaluation period was 3 months. Results No varicocele recurrences were clinically detectable after our surgical approach, No hydrocele formation, and There was improvement in the parameters of semen analysis in the entire patients presented with infertility associated with varicocele as regard improvement in the count, motility, and decrease in the abnormal forms 3 months after varicocelectomy. Conclusion Extended varicocele ligation with delivery of the testis achieve good surgical outcome with minimal varicocele recurrence and hydrocele formation, and offer beneficial effect on semen parameters.

Outcome of using plat eletrich plasma in postextractional wound treatment

Background. Platelet-enriched plasma (PRP) is a revolutionary autologous biomaterial that stimulates bone regeneration, enhances regenerative processes and postoperative wound healing, thus simplifying future implant-prosthetic rehabilitation. Objective of the study. Evaluation of PRP regeneration properties in postextractional wound regeneration. Material and Methods. The clinical examination was used as research methods: inspection, palpation, paraclinical examination: panoramic radiography / CBCT and VAS test were performed. The diagnosis and treatment plan were established, as follows: extraction associated with PRP injection. Results. At the postoperative evaluation of the patient after 7 days of treatment, the intensity of pain according to the modified VAS method showed decreased values- from 4 to 1, the postextractional wound was completely healed, the level of regeneration was attested by the absence of dehiscence, presence of the pale pink epithelium, absence of the postoperative facial edema according to the craniometric points, the Celsius signs also were absent. Conclusion. The use of PRP biomaterial in wisdom tooth extraction is a minimally invasive method of tissue regeneration that reduces the rehabilitation period and prevents the occurrence of post-extraction complications.

Interobserver and Intraobserver Reliabilities of Three-Dimensional Postoperative Evaluation Software in Total Hip Arthroplasty

Background. In primary and revision total hip arthroplasty, to prevent perioperative complications, the prediction of the optimal implant size is essential. Using three-dimensional computed tomography-based postoperative evaluation software, we explored the accuracy and the precision of measurement of the size, alignment, and position of the prosthetic components after total hip arthroplasty. Methods. Using postoperative evaluation software, the postoperative computed tomography data from 20 hips in 20 patients were evaluated. The component size, alignment, and three-dimensional positioning of the cup and stem were assessed. The concordance rates of the component, repeatability (intraobserver reliability), and reproducibility (interobserver reliability) of postoperative evaluation were calculated. The radiographic inclination and radiographic anteversion of the cup, anteversion, varus–valgus angle, and flexion–extension angles of the stem were measured for alignment. The implant positioning was measured along three axes, namely, X-axis (transverse), Y-axis (sagittal), and Z-axis (longitudinal). Results. The concordance rates of all parts are above 94%. The intraobserver and interobserver intraclass correlation coefficients of alignment measurement were very good for both cup (0.879–0.964) and stem (0.973–0.996). The intraobserver and interobserver intraclass correlation coefficients of cup positioning were very good (0.961–0.987) for all axes. The intraobserver and interobserver intraclass correlation coefficients of implant positioning were very good for the stem (0.879–0.995) for all axes. Conclusions. Computed tomography-based postoperative evaluation software was able to evaluate the size and position of total hip implants with high reproducibility.

Predicting lipoabdominoplasty complications with infrared thermography: a delta-R analysis

The diagnosis of the main complications resulting from lipoabdominoplasty has not yet been standardized. Infrared thermal imaging has been used to assess possible complications, such as necrosis and changes in micro- and macro-circulation, based on perforator mapping techniques, among others. The objective of this study was to present two clinical cases involving thermal imaging monitoring of the healing process of lipoabdominoplasty in the immediate postoperative evaluation and its preliminary results. Infrared thermography was performed 24 hours after the operation and on postoperative days 5, 25, and 27. In clinical case 1, it was found that the delta-R (∆TR)–defined as the difference in minimum temperature between the highest and lowest points in the SA3 region (caution suction area) following the classification established by Matarasso–was 0.4°C at 24 hours after surgery and decreased to 0.1°C on a postoperative day 5. There were no complications in this case. In contrast, in clinical case 2, the ∆TR was 1.7°C at 24 hours after surgery (upon hospital discharge) and remained high, at 2.2°C, on postoperative day 5. A higher ∆TR was found in the second patient, who developed necrosis of the surgical wound. The ∆TR thermal index may be a new tool for predicting possible complications, complementing the clinical evaluation and therapeutic decision-making.