Role of zoledronic acid in treatment of osteoporosis and prevention of fractures

Introduction. One of the causes of primary disability and high mortality, among patients with osteoporosis, are fractures that occur with minimal trauma, as a rule, it is a fall from the height of one’s own height. The final link in the chain of preventive measures to reduce the frequency of osteoporosis and fractures on its background is the introduction of pharmacological correction of bone deficiency into the practical activity of an orthopedic traumatologist. Currently, there are several drugs that can change the disturbed metabolism. For example, the use of zoledronic acid significantly reduces the risk of fractures.Aim: to study the effect of zoledronic acid on bone mineral density in patients with osteoporosis complicated by a fracture of proximal end of the femur.Materials and methods. In a prospective cohort study, 14 patients received zoledronic acid for 2 years.Results. When comparing BMD L2-L4, it was revealed that a year after the start of treatment, its increase relative to the baseline value was 4.6%, but was statistically insignificant (0.86 ± 0.078 g/cm2 versus 0.90 ± 0.08 g/cm2, p > 0.05). After 2 years of treatment, the BMD of this segment increased, relative to the baseline values, by 12% and the differences became statistically significant (0.86 ± 0.078 g/cm2 compared to 0.97 ± 0.076 g/cm2, p < 0.05). The increase in BMD for the second year of treatment by 6% was statistically significantly different from the increase for the first year of treatment (0.90 ± 0.08 g/cm2 compared to 0.97 ± 0.076 g/cm2, p < 0.05).A comparative analysis of the basic units of the IPC hip after 1 and 2 years of treatment did not reveal significant differences: 0.7075 ± 0.046 g/cm2 compared to 0.7079 ± 0.034 g/cm2 and 0.70751 ± 0.046 g/cm2 compared to 0.6630 ± 0.97 g/cm2, p > 0.05. In any case, for 2 years not marked new vertebral body fractures. Only one patient had a fracture of the radius in the distal third. The quality of life, after 2 years, significantly improved on the scale of “habitual daily activities” (p = 0.007), decreased indicators on the scale of “anxiety” and “depression” (p > 0.05).Discussion. The study confirmed that even in the presence of pronounced bone loss, pharmacological correction of impaired remodeling reduces the risk of new fractures and improves the quality of life.Conclusion. Pharmacotherapy with zoledronic acid, in our study, confirmed its effectiveness in the treatment of osteoporosis.

SIS therapy in the treatment of distal radius epiphyseal fracture (Case report)

Introduction. Fractures of the distal radius epiphysis are the most common fractures of the upper limb, present both in the general population active following major trauma and in the elderly population in minimal trauma due to osteoporosis. Among the adjuvant therapies for orthopedic treatment of distal radius epiphyseal fracture we can list Super Inductive System (SIS), a therapy based on the interaction between the electric field and the human body with the improvement of the healing process by acting on the pathophysiological stages of bone callus. Material and method. A clinical case study was performed on a 28-year-old patient, hospitalized and treated in the neurosurgery department of the Constanta County and Emergency Hospital for a polytrauma by road accident (passenger) with amyelotic cervical vertebral trauma, thoracic trauma and trauma to the right upper limb, subsequently performing 12 SIS therapy sessions at the Balneal and Rehabilitation Sanatorium of Techirghiol. CT examination of the cervical spine reveals fractures of C4 vertebra (the blade and pedicle) and C5 vertebra (vertebral body, lamina and pedicle). Right forearm radiography reveals fracture of the right radial styloid. After conservative treatment of the cervical injury and orthopedic treatment of the upper limb injury, the clinical evolution is favorable, allowing the patient to be discharged and allowed to do 12 sessions of SIS therapy, 3 times a week, within 4 weeks. The subsequent clinical and paraclinical evolution was favorable for the outpatient orthopedic ambulatory reevaluation performed at 5 weeks. Results and discussions. Due to the type of fracture of the radial distal epiphysis (linear fracture without displacement), absence of comorbidities and young age, led to the indication of orthopedic treatment with immobilization in the antebrachio-palmarcast, which allowed subsequent physiotherapy. Keywords: radial fracture, callus, polytrauma, cervical spine, lamina, Super Inductive System,

Analysis of safety and efficacy of laparoscopic distal pancreatectomy in the treatment of left pancreatic malignant tumors

Objective Distal pancreatectomy is the most extensive operation to treat malignant tumors of the left pancreas; however, malignant pancreatic tumors are prone to early invasion and metastasis. Methods The clinical data of 80 patients undergoing surgical treatment for malignant tumors of the pancreatic body or tail from January 2013 to December 2017 were retrospectively analyzed. The main clinical variables were compared between patients undergoing laparoscopic distal pancreatectomy (LDP) vs. open distal pancreatectomy (ODP). Results There were no significant differences in general patient characteristics, complications, and postoperative survival (χ2 = 0.09) between the groups. The operation time in the LDP group was significantly longer than that in the ODP group; however, the LDP group was superior to the ODP group regarding the length of postoperative hospital stay, diet recovery, and rectal exhaust and ambulation times. Conclusion LDP is a safe and feasible treatment for left pancreatic malignancies, with the same surgical efficacy as ODP. LDP also has the advantages of minimally invasive surgery, such as minimal trauma and enhanced recovery after surgery.

THE CURRENT STATE OF DIAGNOSIS AND TREATMENT OF THE CONGENITAL TIBIA PSEUDOARTHROSIS

Congenital pseudarthrosis of the tibia (CPT) is a rare disease that is detected with a frequency of 1 in 140–250,000 newborns. The disease is characterized by a wide range of clinical and radiological signs from progressive antecurvature deformation of the tibia to nonunion with a significant bone defect. Changes in the CPT area are caused by the influence of pathologically altered periosteum, which forms a fibrous hamartoma and is responsible for the deformityof the biomechanical properties of bone tissue. CPT can be formed at the moment of birth or developed spontaneously or as a result of minimal trauma in the early years. The main method of treatment of CPT is a surgery. Nowadays a number of surgical techniques, which are actively used and improved by specialists in the world, has been developed, The most used methods are the Ilizarovʼs method, application of intramedullary fixators, techniques with the use of vascularized tibial autograft, «induced membrane» technique. However, there are a few studies on comparing the effectiveness of different techniques or metal fixatives, most of them are presented in the format of a retrospective analysis of clinical cases series. This is due to the rarity of the disease and the lack of unified approaches on the choice of surgical treatment techniques. The main aim of surgical treatment of CPT is to achieveconsolidation in the area of pseudoarthrosis, which may restore the limb resistance. The part of primary consolidation of CPT after using the surgical treatment various techniques varies very much, range from 60 to 100 %. The percentage of children with CPT tibial amputations has decreased significantly over the past 30 years, which generally indicates an improvement of the results of surgical treatment of the mentioned pathology. However, CPT still remains one of the most difficult diseases of pediatric orthopedics due to the large number of unsatisfactory results and complications after surgery.

Effectiveness and safety of 0.5% timolol solution in the treatment of pyogenic granuloma: A randomized, double-blind and placebo-controlled study

Introduction: Pyogenic granulomas are benign vascular lesions of the skin and mucosa which are often a source of concern because of their recurrent bleeding even with minimal trauma. Current treatment for pyogenic granuloma is ablative; no medical therapy is standardized to date. Timolol, due to its vasoconstrictive effect, vascular growth factor inhibition and apoptosis promotion properties, is a potential therapeutic option. Objectives: To assess the effectiveness and safety of topical timolol in the treatment of pyogenic granulomas. Methods: A two-centre, double-blind and placebo-controlled trial (Registration CTRI/2019/04/018581) was conducted. Patients of either sex were recruited with pyogenic granuloma lesions of less than eight weeks duration. Topical treatment with 0.5% timolol or matching glycerin placebo was continued for six weeks. Changes in color, size, bleeding tendency, physicians’ and patients’ global assessments and adverse events were assessed. Results: Forty subjects were randomized between the two groups which were comparable in age, sex, duration of illness and baseline lesion size.Significant improvement was noted with timolol, with color change from first follow-up onwards and lesion size reduction from second follow-up onward. Patients’ assessment of bleeding tendency also showed imrovement from the second visit onward. Between-group comparison showed significant difference with respect to percentage reduction in size (timolol 40.9%, placebo 3.4%; P = 0.002). Rescue treatment (electrosurgery) was required in five patients on placebo and in one in the timolol group (P = 0.182). Complete resolution occurred in 2 (10%) patients with timolol and in no patients on placebo (P = 0.231). Limitations: We observed effects of treatment for only six weeks. Conclusion: Topical timolol may be a treatment option for early pyogenic granulomas but complete resolution is unlikely in six weeks. Studies of longer duration are required to assess resolution and recurrence rates.

Modern view of using gonioassociated trabeculotomy

Purpose. Provide data on the use of gonioscopy-assisted transluminal trabeculotomy (GATT), reflecting its effectiveness and safety when using this technique in various patient models. Material and methods. To perform the review, literature sources which were searched through the PubMed and Scopus databases up to and including 2021, using the keywords "gonioassociated trabeculotomy", "minimally invasive glaucoma surgery", "primary open-angle glaucoma", "glaucoma", "secondary glaucoma". A total of 19 articles related to the topic of the review were selected. The beginning of publications on this topic dates back to 2013. Results. GATT can be used at various stages of glaucoma, but at the same time, the maximum effect of lowering intraocular pressure (IOP) is achieved in patients with an early or middle stage of glaucoma. There are also good results of using the GATT technique after vitreoretinal surgery, with the development of secondary glaucoma or ophthalmic hypertension. One of the advantages of GATT is that all manipulations are performed in the anterior chamber, which in turn makes it possible, if necessary, to perform reoperation after an unsuccessful ad-externo trabeculotomy without re-traumatizing the sclera and conjunctiva. It should be noted that the main complication in all studies is the hyphema, which is completely absorbed within a few days. Conclusion. Based on these studies, it can be concluded that the proposed GATT technique is relevant, and meets all modern standards of minimally invasive glaucoma surgery (MIGS): micro-incision, minimal trauma, is able to effectively reduce IOP, has a high level of safety and quick recovery. Key words: glaucoma, primary open-angle glaucoma, secondary glaucoma, gonioassociated trabeculotomy, minimally invasive glaucoma surgery, surgical treatment of glaucoma

Edukasi Persiapan Persalinan Pada Pasangan Hamil Dalam Menyambut Persalinan Minim Trauma

ABSTRAK Psikologis ibu dalam hal ini kecemasan dapat mempengaruhi kemajuan persalinan. Edukasi persalinan dilakukan untuk mempersiapkan ibu dalam menghadapi persalinan secara fisik dan khususnya persiapan psikologis. Edukasi dianggap cara terbaik dalam mempersiapkan persalinan. Kegiatan ini bertujuan untuk meningkatkan pengetahuan ibu hamil dan pasangannya di PMB Jeanne Kota Depok. Metode yang digunakan adalah presentasi dan simulasi pada kelas ibu hamil, dilakukan juga variasi kegiatan secara outdoor dan indoor agar penyampaian lebih menarik. Hasil dari kegiatan ini efektif, terlihat antusias peserta dalam mengajukan pertanyaan. Peserta edukasi menyatakan lebih siap dan mengerti dalam menghadapi persalinan. Diharapkan kelas edukasi dapat dilaksanakan secara periodik sehingga lebih banyak lagi pasangan yang teredukasi dan siap menghadapi kehamilan dan persalinan dengan nyaman dan minim trauma. Kata kunci: kehamilan; pendidikan saat hamil; edukasi persalinan ABSTRACT Psychologically, in this case, anxiety can affect the progress of labor. Childbirth education is carried out to prepare mothers for physical delivery and especially psychological preparation. Education is considered the best way to prepare for labor. This activity aims to increase knowledge of pregnant couples at PMB Jeanne Depok City. The methods used are presentations and class simulations for pregnant women, as well as a variety of outdoor and indoor activities so that the delivery was more interesting. The results of this activity were effective, it was seen that the participants were enthusiastic in asking questions. Educational participants were more prepared and understanding in dealing with childbirth. It is hoped that education classes can be carried out periodically so that more couples are educated and ready to face pregnancy and childbirth comfortably and with minimal trauma. Keywords: pregnancy; education during pregnancy; childbirth education

Rapidly Evolving Deep Dissecting Hematoma With Sudden Onset, Developed One Month After A Minimal Trauma.

Background: Deep dissecting hematoma is a rapidly extending blood collection that splits the hypodermis from muscle fascia, constituting a medical surgical emergency. The natural history of this condition includes trauma (even minor physical injury) shortly before onset of the lesion, occurring in a patient with advanced dermatoporosis. Case presentation: We report the admission of a 70-year-old woman to the emergency department of our hospital for the onset of a deep dissecting hematoma one month after a negligible trauma in the right leg, complicating secondary iatrogenic dermatoporosis. Bedside ultrasound examination was used to eliminate differential or additional diagnoses and to assess the main features of the hematoma (dimensions, existence of blood supply). Surgical debridement and hematoma drainage were performed due to rapid horizontal extension of the hematoma and unresolved pain, with the operative report confirming the diagnosis. Conclusion: This observation emphasises that in patients with severe dermatoporosis, several weeks can elapse between a minor impact and the sudden development of a limb-threatening deep dissecting hematoma.

A Robotic System with Robust Remote Center Motion Constraint for Endometrial Regeneration Surgery

Surgical robots have been widely used in various surgeries in order to improve and facilitate the surgeries. However, there is no robot intended for endometrial regeneration surgery which is a new therapy to restore women’s fertility by using stem cells. Endometrial regeneration surgery requires processing endometrium and transplanting stem cells with the minimal trauma to uterus. In this paper, we introduce a surgical robotic system which consists of a dexterous hysteroscope, a supporting arm and additional novel instruments to facilitate the operations and decrease trauma to the uterus. To protect the cervix of the uterus, remote center of motion (RCM) constraint is required. First, the supporting arm and the hysteroscope are controlled separately in kinematics in order to ensure that the RCM constraint and the hysteroscope’s shape and posture are predictable. Then, a task decoupled method is used to improve the robustness of the RCM constraint. The experiments show that our method is more robust and achieves higher accuracy of RCM. Besides, the master slave control of robot with RCM constraint is also verified.