Arthroscopic capsular release for adhesive capsulitis secondary to diabetes provides better functional outcome than conservative management

Objectives: Comparison of outcome of subacromial bursal resection with capsular release for adhesive capsulitis of shoulder secondary to diabetes, with conservative management. Materials and Methods: This study was conducted on 68 patients of adhesive capsulitis of shoulder secondary to diabetes. The patients were divided into two groups: Arthroscopic capsular release group (group I n 32) and Conservative management group (Group II n 36) after fulfilling inclusion/ exclusion criteria. Follow-up was done at 2, 6, 24 weeks, 6 months, 1 year, and 2 years. In addition to pre-operative measurement, at each follow-up pain was assessed by visual analog scale (VAS), range of motion (ROM) was assessed by goniometer and functional outcome was assessed by Constant-Murley score. Values obtained were filled in Excel sheet and analyzed by independent t-test, Wilcoxon Rankosin test, and Analysis of Variance test on Statistical Package for the Social Sciences software. Results: Two patients in Group I and six in Group II were lost to follow-up. There was statistically significant improvement in VAS of both groups at each follow-up, but the noticeable difference was that the patients in arthroscopic release group were pain free by 6 weeks and the pain relief was sustained till final follow-up. In contrast, though there was pain relief in conservative group but they were not completely pain free till final follow-up. There was statistically significant improvement in Constant Murley score in both groups at each follow-up but arthroscopic release group achieved near normal score by 6 months and the improvement was maintained till last follow-up. The comparison of mean and median values of ROM, between the arthroscopic capsular release group and conservative group were statistically significant (P value of 0.001) for each movement. Conclusion: The improvement in ROM, decrease in pain, and functional outcome are better in diabetic patients with adhesive capsulitis undergoing Arthroscopic capsular release than conservative management.

Behavioural mechanisms affecting the success of translocations. An investigation using New Zealand’s rarest ratite, the rowi

<p>Translocations are increasingly being used for conservation management of threatened species (Sarrazin & Legendre, 2000). Outcomes are influenced by a range of factors including effects of early rearing experience, conspecific familiarity, density of resident conspecifics, and habitat quality at the release site, all of which may impact on the behaviour of released individuals and subsequent survival and fitness (Law & Linklater, 2007; Linklater & Swaisgood, 2008; Sarrazin & Legendre, 2000). Conservation success, defined as the realisation of goals set out at the start of a project, can be improved by detecting factors causing suboptimal outcomes and identifying potential solutions (Buner et al., 2011; Green et al., 2005; Mihoub et al., 2011). I aimed to expand current knowledge on factors influencing translocation outcomes by investigating the conservation management of the rowi (Apteryx rowi), the rarest species of kiwi. Current rowi conservation practices provide an opportunity to investigate this type of translocation management model. I provide new evidence and knowledge of behavioural mechanisms driving translocation success, include an expansion of current home range cognitive mapping theory relevant to conservation translocations, and present the first study of rowi home range behaviour (defined as the pattern of space use which leads to the emergence of a stable home range). Rowi conservation management involves removing eggs from the wild, hatching chicks in captivity, rearing on a predator free island until they are large enough to no longer be at risk of predation by stoats (Mustela erminae), then translocation back into the single remaining mainland population at Ōkārito forest. Over three years, experimental releases (n=66) were undertaken into both the existing population of rowi at South Ōkārito, and into an adjacent but unoccupied area of their former range at North Ōkārito. After intensive post-release monitoring, the effects of various elements of the translocation process on post-release survival, dispersal, conspecific association, habitat selection and home range behaviour were examined. An investigation into the effects of season of release, conspecific density, sex, and release group size on survival during the 90 day critical period following release, found release season and release group size are the most likely factors to influence post-release survival, with highest survival in spring, and for large release groups of four or more birds per release site. Habitat quality throughout the Ōkārito forest was estimated using invertebrate biomass as a proxy. A Geographic Information Systems (GIS) layer showing relative estimated invertebrate biomass was created and used to provide values of habitat quality at release locations and within home ranges. An investigation of the influence of habitat quality on post-release dispersal, conspecific association and home range behaviour found maximum dispersal distance was affected by the release site (North or South Ōkārito), and the interaction of release site and the estimated invertebrate biomass at the release location. Mean home ranges (± SE) of translocated rowi (3.35 ± 0.37 km²), were larger and of lower habitat quality than those of wild rowi (1.06 ± 0.09 km²). No effects of release group size on dispersal distance or conspecific association rates post-release were found. The effects of early rearing experience are proposed as a key factor influencing translocated rowi behaviour. By monitoring the survival, dispersal, conspecific association and home range behaviour resulting from the translocation of rowi reared in a non-natural social situation, I highlight the potential impact of prior social experience and social memory on cognitive mapping and home range establishment. This innovative approach has the potential to be a valuable expansion to current home range cognitive mapping theory, and warrants further study. Translocation is a vital tool in conservation, and has undoubtedly been instrumental in improving the situation of rowi since the first application to rowi conservation in the 1990s. This study has demonstrated that further improvements in the effectiveness and efficiency of translocations for conservation can be gained through sound scientific analysis of factors affecting the mechanisms leading to translocation success. Ongoing monitoring, analysis and reassessment of translocation management practices are recommended to ensure optimal conservation outcomes.</p>

Behavioural mechanisms affecting the success of translocations. An investigation using New Zealand’s rarest ratite, the rowi

<p>Translocations are increasingly being used for conservation management of threatened species (Sarrazin & Legendre, 2000). Outcomes are influenced by a range of factors including effects of early rearing experience, conspecific familiarity, density of resident conspecifics, and habitat quality at the release site, all of which may impact on the behaviour of released individuals and subsequent survival and fitness (Law & Linklater, 2007; Linklater & Swaisgood, 2008; Sarrazin & Legendre, 2000). Conservation success, defined as the realisation of goals set out at the start of a project, can be improved by detecting factors causing suboptimal outcomes and identifying potential solutions (Buner et al., 2011; Green et al., 2005; Mihoub et al., 2011). I aimed to expand current knowledge on factors influencing translocation outcomes by investigating the conservation management of the rowi (Apteryx rowi), the rarest species of kiwi. Current rowi conservation practices provide an opportunity to investigate this type of translocation management model. I provide new evidence and knowledge of behavioural mechanisms driving translocation success, include an expansion of current home range cognitive mapping theory relevant to conservation translocations, and present the first study of rowi home range behaviour (defined as the pattern of space use which leads to the emergence of a stable home range). Rowi conservation management involves removing eggs from the wild, hatching chicks in captivity, rearing on a predator free island until they are large enough to no longer be at risk of predation by stoats (Mustela erminae), then translocation back into the single remaining mainland population at Ōkārito forest. Over three years, experimental releases (n=66) were undertaken into both the existing population of rowi at South Ōkārito, and into an adjacent but unoccupied area of their former range at North Ōkārito. After intensive post-release monitoring, the effects of various elements of the translocation process on post-release survival, dispersal, conspecific association, habitat selection and home range behaviour were examined. An investigation into the effects of season of release, conspecific density, sex, and release group size on survival during the 90 day critical period following release, found release season and release group size are the most likely factors to influence post-release survival, with highest survival in spring, and for large release groups of four or more birds per release site. Habitat quality throughout the Ōkārito forest was estimated using invertebrate biomass as a proxy. A Geographic Information Systems (GIS) layer showing relative estimated invertebrate biomass was created and used to provide values of habitat quality at release locations and within home ranges. An investigation of the influence of habitat quality on post-release dispersal, conspecific association and home range behaviour found maximum dispersal distance was affected by the release site (North or South Ōkārito), and the interaction of release site and the estimated invertebrate biomass at the release location. Mean home ranges (± SE) of translocated rowi (3.35 ± 0.37 km²), were larger and of lower habitat quality than those of wild rowi (1.06 ± 0.09 km²). No effects of release group size on dispersal distance or conspecific association rates post-release were found. The effects of early rearing experience are proposed as a key factor influencing translocated rowi behaviour. By monitoring the survival, dispersal, conspecific association and home range behaviour resulting from the translocation of rowi reared in a non-natural social situation, I highlight the potential impact of prior social experience and social memory on cognitive mapping and home range establishment. This innovative approach has the potential to be a valuable expansion to current home range cognitive mapping theory, and warrants further study. Translocation is a vital tool in conservation, and has undoubtedly been instrumental in improving the situation of rowi since the first application to rowi conservation in the 1990s. This study has demonstrated that further improvements in the effectiveness and efficiency of translocations for conservation can be gained through sound scientific analysis of factors affecting the mechanisms leading to translocation success. Ongoing monitoring, analysis and reassessment of translocation management practices are recommended to ensure optimal conservation outcomes.</p>

Unplanned Office Visits Following Outpatient Hand Surgery

Background Returning to the office for an unplanned visit postoperatively can be burdensome to both the patient and provider. The purpose of this study was to quantify the rate of unplanned office visits after common soft tissue hand surgeries and assess the reasons for these unplanned visits. Methods Patients who underwent common soft tissue hand surgeries over a 6-month time period were queried from an electronic medical record database. Manual chart review was performed to record patient demographics, unplanned visits within 3 months postoperatively, and specific reasons for unplanned visits. A total of 1648 postoperative follow-up visits in 1224 patients were included in analysis. Results Within 3 months of surgery, 6.3% (103/1648) of postoperative visits were found to be unplanned. There was no difference in the rate of unplanned visits among the included surgeries ( P = .46). The most common reasons for an unplanned office visit overall were wound problems (34%), pain (23.3%), and stiffness (17.5%). The trigger finger release group had significantly more patients return to the office for stiffness ( P = .01), the De Quervain release group had significantly more patients return for pain ( P = .02), and the carpal tunnel release group had significantly more patients return for persistent symptoms ( P < .05). Conclusions Unplanned office visits represented about 1 of 16 postoperative visits. Orthopedic surgeons should be aware of the most common reasons for these visits and be prepared to address these problems promptly. Preoperative patient education on these potential problems may help decrease the frequency of unplanned follow-up visits.

Outcomes of Arthroscopic Nerve Release in Patients Treated for Large or Massive Rotator Cuff Tears and Associated Suprascapular Neuropathy: A Prospective, Randomized, Double-Blinded Clinical Trial

Background: Suprascapular neuropathy has been observed in the setting of rotator cuff tears (RCTs), but its association with these tears and their treatment are unclear. Hypothesis: Arthroscopic suprascapular nerve release during rotator cuff repair will not alter the outcomes of neuropathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 42 patients with large/massive reparable RCTs and suprascapular neuropathy were recruited and followed up at 6 and 12 months. Electrophysiological results as well as Disabilities of the Arm, Shoulder and Hand (DASH), American Shoulder and Elbow Surgeons (ASES), and Constant scores were evaluated at selected time periods. Patients were randomly assigned to 2 groups. Patients in the control group underwent arthroscopic repair of the rotator cuff without combined arthroscopic release of the superior transverse scapular ligament; in the second group, the superior transverse ligament was released. The primary outcome was to examine full suprascapular nerve recovery through electrophysiological changes between groups. The secondary/tertiary outcomes were analysis of clinical outcomes and assessment of the relation between RCT size and the degree of suprascapular nerve recovery. Patients, clinical staff members, and the neurologist were blinded to the type of surgical procedure. Results: Of 42 patients, 37 completed the follow-up at 12 months (median age, 64 years [range, 50-75 years]). Overall, 17 of 19 (89.5%) patients in the control group and 15 of 18 (83.3%) patients in the nerve release group had full nerve recovery, with no significant difference between the 2 groups. Clinically, all patients in both groups showed a significant improvement ( P < .001), but no significant difference was observed between the 2 groups in terms of 12-month postoperative scores (control group: DASH: median, 5 [range, 0-21]; ASES: median, 88 [range, 83-98]; Constant: median, 86 [range, 70-98]) (nerve release group: DASH: median, 6 [range, 0-25]; ASES: median, 90 [range, 83-98]; Constant: median, 88 [range, 75-98]). Also, no significant difference was found between the 2 groups regarding other secondary and tertiary outcomes. Conclusion: Combined arthroscopic release of the superior transverse scapular ligament and rotator cuff repair in patients with large/massive RCTs and suprascapular neuropathy did not produce statistically significant improved outcomes compared with repair of the rotator cuff alone. Registration: NCT02318381 (ClinicalTrials.gov identifier).

Rapid popliteal artery release sensu A.N. Kazantsev in acute thrombosis in patients with COVID-19

Aim. To analyze the outcomes of popliteal thrombectomy using the standard release technique with vascular instruments and rapid release sensu A. N. Kazantsev in patients with acute popliteal artery thrombosis (PAT) and coronavirus disease 2019 (COVID-19).Material and methods. The present prospective single-center study for the period from April 1, 2020 to March 17, 2021 included 157 patients with acute PAT and COVID-19 at the Alexandrovskaya City Hospital. All patients were divided into 2 groups depending on the popliteal artery access: group 1 (n=88; 56%) — rapid release sensu A. N. Kazantsev; group 2 (n=69; 44%) — standard popliteal artery release using vascular instruments (vascular forceps and scissors) and tourniquets. Rapid popliteal artery release was distinguished by the fact that fasciotomy and hemostasis, the fatty tissue behind it and up to the artery was torn with two index fingers. First, the fingers were joined together at the lateral edges and inserted into the wound middle. Then the wound together with tissues was stretched with fingers to proximal and distal edges until the popliteal artery was visualized. Further, a Beckmann retractor was used to fix the torn fiber to the upper and lower wound walls. The tourniquets were not used.Results. Surgical access duration (group 1, 4,5±1,3 minutes; group 2, 11,41±0,9 minutes; p=0,005), as well as the total procedure duration (group 1, 47,5±2,8 minutes; group 2, 62,15±4,5 min; p=0,001) had the lowest values in the group of rapid popliteal artery release. Moreover, all intraoperative bleedings (n=11; 15,9%) was recorded in group 2 as a result of popliteal vein injuries and/or bleeding from popliteal artery. The retrombosis rate in the rapid release group was lower (group 1, 40,9%; group 2, 55,1%; p=0,03). On the first day after surgery, 18% of thrombosis developed in group 1, and 39% in group 2. The mortality rate was highest in the standard artery release group (group 1, 55,7%; group 2, 86,9%; p<0,0001; OR, 0,18; 95% CI, 0,08-0,42). In all cases, the cause of death was systemic multiple organ failure due to severe pneumonia, pulmonary edema, and cytokine storm.Conclusion. The use of rapid popliteal artery release sensu A. N. Kazantsev significantly reduces the thrombectomy duration in the context of COVID-19. This effect is achieved due to a decrease in the incidence of intraoperative bleeding, no need to use tourniquets and vascular instruments. A decrease in the ischemia duration using novel release technique reduces the retrombosis rate, as well as deaths caused by systemic multiple organ failure against the background of hyperperfusion and compartment syndrome. Reducing the operation duration with the use of rapid popliteal artery release sensu A. N. Kazantsev reduces the time of intraoperative mechanical ventilation, which in COVID-19 patients reduces the risks of pneumothorax, pneumomediastinum, emphysema, and pulmonary embolism. Thus, the rapid popliteal artery release sensu A. N. Kazantsev can be recommended for popliteal thrombectomy in patients with COVID-19.

Is Pulley Reconstruction Better Than Pulley Release for De Quervain's Tenosynovitis? A Double-Blind Randomized Controlled Trial

Purpose The aim of this study was to compare the results of surgeries of the De Quervain's disease (DQD) through a randomized control trial.Materials and Methods We treated 40 cases of De Quervain's tenosynovitis in 2 groups: 20 patients by pulley release method and another 20 patients by pulley reconstruction method. The patients were selected as per the random table number. The clinical data, numeric Visual Analogue Scale (VAS) score, Quick DASH—Disabilities of the Arm, Shoulder, and Hand—score, Mayo Wrist Score, and subluxation of the tendons in dynamic ultrasonography (USG) during wrist hyperflexion and abduction of the thumb test were noted preoperatively and 6 months after the operation. All patient charts were reviewed and data analysis was done after completion of the study.Results All patients improved after surgery. There was no difference in clinical outcome data, numeric VAS score, Quick DASH Score, and Mayo Wrist Score (p-value > 0.05). There were four patients with tendon subluxation under USG in pulley release group, out of which only one patient was clinically symptomatic. There was no tendon subluxation in pulley reconstruction group. The tendon subluxation between the two groups was not found to be statistically significant (p-value: 0.661).Conclusion Although, higher numbers of subluxation were found in release group, there was no statistically significant difference in the outcome of the two surgical procedures for DQD. This study is a pilot study, and it may act as the groundwork over which further studies may be performed.Level of Evidence This is a Level I study.

Risk factors for refusing to continue medical follow-up by tuberculosis patients detected in the penitentiary system of the Russian Federation

One of the essential problem sisthelack of continuity of medical follow-up and treatment of tuberculosis patients released from the penitentiary units and transferred tocivilian medical services. Mostly it is due to the fact that patients released from prisons are reluctant to continue medical follow up needed for their disease of tuberculosis or risk of its reactivation.The objective of the study: to find out the predictors of avoidance behavior in tuberculosis patients released from the penitentiary system of Russia resulting in reluctance to continue medical follow-up.Subjects and methods. During the case-control study, the information about 75 patients was investigated; those patients were detected in the penitentiary system in the period with 2014 2018 and released by the moment when the study was conducted. Ofthem, 62 referred to TB dispensary to continue follow-up and 13 didn't. The following predictors of the failure to continue medical follow-up were found out: the lackofa regular place of residence or foreign citizen ship; tuberculosis with minimal lesions and the negative result of the sputum test; clinically cured tuberculosis at the moment of release (Group III of dispensary follow-up). The regular place of residence, certain concurrent somatic conditions, and virus hepatites contributed to the willingness of patients to continue follow-up in the civilian medical system including due to tuberculosis.

Anatomy of Rouviere’s Sulcus and Its Association with Complication of Laparoscopic Cholecystectomy

Background and Objective(s). Rouviere’s sulcus (RS) is an important anatomical landmark. The aim of this study was to find the distribution of anatomical characteristics of RS seen during laparoscopic cholecystectomy in the population of our part of the world and its association with complications. Methods. This is a prospective observational study involving patients of age ≥16 years who underwent laparoscopic cholecystectomy for uncomplicated gall stone at BPKIHS between May and July 2019. Result. 230 cases were analyzed, and RS was present in 90.4%. Open sulcus type was the commonest (54%), followed by scar type (22.9%), closed sulcus type (12.5%), and slit type (10.6%), respectively. In 59.1% of cases, it was oblique to the anterior, inferior, and external edge of the liver, while in the remaining cases, it was transverse. The mean ± SD values for operative time and duration of hospital stay in the RS visible and the RS not visible groups were 29.16 ± 8.736 and 42.9 ± 23.646 minutes, and 1.26 ± 0.440 and 1.90 ± 0.910 days, respectively (p value ≤0.001). One minor complication occurred in each group: RS initially visible group and RS visible on the adhesion release group, while 3 minor complications occurred in the RS not visible group. Only one major complication occurred in the RS not visible group. Conclusion. Identification of RS by operating surgeons is a predictor of safe laparoscopic cholecystectomy.

Anatomical Study of Minimally Invasive Lateral Release Techniques for Hallux Valgus Treatment

Background: Lateral release (LR) for the treatment of hallux valgus is a routinely performed technique, either by means of open or minimally invasive (MI) surgery. Despite this, there is no available evidence of the efficacy and safety of MI lateral release. Our aim was to study 2 popular techniques for MI LR in cadavers by subsequently dissecting the released anatomical structures. Methods: Twenty-two cadaveric feet were included in the study and allocated into 2 groups, 1 for each procedure: 1 group underwent a MI adductor tendon release (AR), and in the other group, an extensive percutaneous lateral release (EPLR) (adductor tendon, suspensory ligament, phalanx-sesamoid ligament, lateral head of flexor hallucis brevis, and deep transverse metatarsal ligament) was performed. Anatomical dissection was performed to identify neurovascular injuries and to verify the released structures. Results: Both techniques demonstrated to be effective in reproducing a MI LR. A satisfactory release of the adductor tendon was achieved equally in both techniques ( P = .85), being partial in most EPLR cases and full in the majority of AR cases. The EPLR was successful in releasing the intended additional structures ( P < .05). One case of inadvertent complete section of the flexor hallucis longus was identified in the percutaneous adductor tendon release group. No cases of dorsolateral nerve injury were seen with either of the techniques. Conclusion: Percutaneous lateral release was a reliable and accurate technique in this cadaveric model. The MI AR proved to be more effective in fully releasing the adductor tendon while the ER was intended and able to release a number of other structures. Clinical Relevance: MI LR is a safe procedure that could obviate the need for open surgery to achieve the same surgical goal. It can be associated to either open or MI osteotomies in the correction of hallux valgus.