Is preoperative bone conduction shape a prognostic factor in otosclerosis surgery?

1. We focused on 175 patients operated on for otosclerosis. There were 89 in group 1 (preoperative 4000 Hz BC threshold better than 2000 Hz) and 86 in group 2 (preoperative 2000 Hz BC threshold better than 4000 Hz). 2. Preoperatively, there was no significant difference in terms of average bone conduction (BC) thresholds, average air conduction (AC) thresholds and air-bone gap (ABG) between the two groups. 3. Three months and 1 year after surgery, group 1 had better audiometric outcomes than group 2 in terms of average AC and BC thresholds and ABG. 4. Postoperative BC gain was better in group 1 than group 2, particularly at 500 Hz, 1000 Hz and 2000 Hz. 5. When the 4000 Hz BC threshold was preoperatively impaired (group 2), it was not worsened after stapes surgery. This was not the case in group 1.

IMMUNOPHENOTYPIC PROFILE OF T ACUTE LYMPHOBLASTIC LEUKAEMIA IN A TERTIARY CARE CENTRE - OUR EXPERIENCE

Background:Studying the immunophenotypic profile of T-ALL patients in Kashmir and correlation of various demographic factors. Methods: 36 patients of all age groups were registered for this study of which 35 were included in the analyses. Result: 82.86% were males and 17.14% were females. 51.43% had common thymocyte T-ALL, 28.57% had pro T-ALL and 20% had mature thymocyte T-ALL. The average age at presentation was 18.60 years. 51.43% were CD1a positive. CD2 was positive in 70.83%. 88.57% were CD5 positive while 100% were positive for CD7. 42.86% were CD34 positive. The average bone marrow blast percentage was 82.43%. The average peripheral blood TLC was 92.73 x 103 cells/cumm. Conclusion: This is the first study to report immunophenotypic and demographic profile of T-ALL in Kashmir with the aim to increase understanding of the disease and contributing to more suitable treatment options.

Bone ingrowth into open architecture PEEK interference screw after ACL reconstruction

Purpose Open or fenestrated interference screw design that allow bone ingrowth is a concept for improved bone healing to softtissue graft and bone filling in bone tunnels after anterior cruciate ligament reconstruction (ACLR) The aim of the current study was to assess CT scanning evaluated bone ingrowth into an open architecture interference screws in the tibial tunnel of patients undergoing ACL with soft tissue grafts. It was hypothesized that open architecture interference screws would stimulate bone ingrowth into the screw cavities. Methods Twelve patients requiring ACLR were included. They underwent arthroscopic ACLR with semitendinosus−/gracilis tendon graft and an open architecture polyetheretherketone (PEEK) interference screw. The patients were scanned with a multi-slice CT scanner two weeks, six and twelve months postoperatively. On CT reconstruction slices bone ingrowth into the screw was measured. Subjective and objective clinical outcome international knee documentation committee score and instrumented knee laxity determination were collected. Results At six months no implants demonstrated more than 10% bone ingrowth. At twelve months 42% (5/12) implants had more than 10% bone ingrowth (p = 0.009). The average bone filling into the screws was 7.7%. There was no tunnel widening or cyst formation seen in relation to any of the implants. Subjective IKDC score improved significantly from 50.6 baseline to 80.1 at 24 month follow-up. Preoperative side-to-side knee laxity improved from 3.7 (2.1) to 1.4 (1.2) mm at twelve months. There were no serious adverse events in relation to the new open architecture thread PEEK interference screw during or after hamstring ACL reconstruction. Conclusion The present study demonstrated that open architecture thread PEEK interference screw can stimulate bone ingrowth into the screws after soft tissue ACL reconstruction with at 12 months with an average bone filling into screws was 7.7%. Knee stability, functional, subjective and objective outcomes were similar to large volume ACL outcome studies. Trial registration The study was registered at ClinicalTrials # NCT02382341. 12-09-2014. Level of evidence IV.

Bone ingrowth into open architecture PEEK interference screw after ACL reconstruction

Purpose Open or fenestrated interference screw design that allow bone ingrowth is a concept for improved bone healing to softtissue graft and bone filling in bone tunnels after anterior cruciate ligament reconstruction (ACLR) The aim of the current study was to assess CT scanning evaluated bone ingrowth into an open architecture interference screws in the tibial tunnel of patients undergoing ACL with soft tissue grafts. It was hypothesized that open architecture interference screws would stimulate bone ingrowth into the screw cavities. Methods Twelve patients requiring ACLR were included. They underwent arthroscopic ACLR with semitendinosus-/gracilis tendon graft and an open architecture polyetheretherketone (PEEK) interference screw. The patients were scanned with a multi-slice CT scanner two weeks, six and twelve months postoperatively. On CT reconstruction slices bone ingrowth into the screw was measured. Subjective and objective clinical outcome international knee documentation committee score and instrumented knee laxity determination were collected. Results At six months no implants demonstrated more than 10 % bone ingrowth. At twelve months 42 % (5/12) implants had more than 10 % bone ingrowth (p = 0.009). The average bone filling into the screws was 7.7 %. There was no tunnel widening or cyst formation seen in relation to any of the implants. Subjective IKDC score improved significantly from 50.6 baseline to 80.1 at 24 month follow-up. Preoperative side-to-side knee laxity improved from 3.7 (2.1) to 1.4 (1.2) mm at twelve months. There were no serious adverse events in relation to the new open architecture thread PEEK interference screw during or after hamstring ACL reconstruction. Conclusion The present study demonstrated that open architecture thread PEEK interference screw can stimulate bone ingrowth into the screws after soft tissue ACL reconstruction with at twelve months with an average bone filling into screws was 7.7 %. Knee stability, functional, subjective and objective outcomes were similar to large volume ACL outcome studies. Trial registration The study was registered at ClinicalTrials # NCT023882341.

Upper Limb after Forearm Lengthening in Patients’ and Physicians’ Perspective

Background. The goal of this study was to perform a functional (subjective) and radiological evaluation of patients who had undergone forearm lengthening by distraction osteogenesis years before. Material and methods. Eleven patients with forearm shortening of various etiology were enrolled. They had undergone a total of 21 lengthening procedures. A retrospective analysis of radiological data was conducted and a subjective evaluation was accomplished by using a modified QuickDASH-9 questionnaire. Results. Average bone lengthening was 3.54cm, and mean lengthening index was 40.53day/cm. Eight pa­tients answered the questionnaire at a mean of 7.8yrs after the treatment. The mean questionnaire score was 9.75pts (of 36). Four patients rated the overall function of the affected limb as improved following distraction, while 3 patients were not able to see any improvement. One patient reported that the lengthening had impaired limb function. With regard to cosmetic aspects, 4 patients reported a worsening after the lengthening procedure while 3 patients reported improvement and 1 patient did not note any changes. Conclusions. 1. Despite deformities and functional limitations, patients after forearm lengthening only occasionally suffered from moderate intensity pain. 2. The radiological outcomes were positive and the rate of complications was low. 3. The radiological outcomes did not match patient-declared functional and cosmetic results.

Alveolar Cleft Reconstruction Using Morphogenetic Protein (rhBMP-2): A Systematic Review and Meta-Analysis

Objective: This study aimed to review the existing evidence regarding reconstruction of the alveolar cleft using recombinant human bone morphogenetic protein-2 (rhBMP-2) in terms of bone volume and bone height. Design: Systematic review and meta-analysis. Patients—Participants: A systematic search was done. Randomized and nonrandomized clinical trials, where rhBMP-2 was used in the reconstruction of human alveolar cleft were included. Interventions: Reconstruction of alveolar cleft with rhBMP-2. Main Outcome Measures: Average bone volume formation and average bone height formation in the alveolar cleft. Mean difference was calculated and pooled by meta-analysis. Results: Of 709 identified articles, 5 studies met the inclusion criteria. The average bone volume formation was higher in the rhBMP-2 group than in the control group (61.11% vs 59.12%). The average bone height formation was higher in the control group compared to the rhBMP-2 group (75.4% vs 61.5%). The risk of bias in the selected articles was high. The meta-analysis showed that rhBMP-2 treatment may benefit bone formation compared to iliac crest graft (low certainty evidence; mean difference: −208.76; 95% confidence interval: −253.59 to −163.93; −I2 = 0%). Conclusions: The results obtained in primary articles are promising but have a high risk of bias and have low quality of evidence; therefore, it is necessary to conduct controlled clinical trials with a greater number of patients to recommend the use of rhBMP-2 in the treatment of the alveolar cleft. PROSPERO registration number: CRD42018077741.

Comparison study of temperature and deformation changes in the femoral component of a novel ceramic-on-ceramic hip resurfacing bearing to a metal standard, using a cadaveric model

Hip resurfacing is an attractive alternative to total hip replacement preserving bone and reducing dislocation risk. Recent metal-on-metal designs have caused failure due to metal wear debris. Ceramic implants may mitigate this risk. Temperature increase in periprosthetic bone during cementation can lead to osteonecrosis, while deformation of the component can affect joint lubrication and may increase wear through clamping. Both processes may lead to implant loosening. This study quantifies the temperature and deformation change in a novel ceramic hip resurfacing femoral component compared to a metal standard during cemented implantation in a fresh frozen cadaveric model. Study design and methods Eight femora were prepared from four fresh frozen cadavers. One surgeon experienced in hip resurfacing surgery (J.H.) prepared the femora by reaming. Four ceramic and four metal implants of equal and varying size were cemented in place. Bone and surface temperatures were taken using a probe in the periprosthetic bone and an infrared laser thermometer, respectively. Deformation was measured using a micrometre. Measurements were taken before implantation and every 5-min intervals up to 30 min. The average bone-temperature increment was lower for ceramic heads than for metal heads. Although this difference was not statistically significant, the average bone temperature incremental change in small sizes (42 and 46 mm) was higher than in the large sizes (48 and 50 mm). Most metal heads sustained bearing diameter change that was still near its peak value 30 min after implantation, whereas the ceramic heads suffered a lower diameter change and most of the samples recovered their original diameter 30 min after implantation. Both implants behave similarly, however, a lower temperature rise in bone was observed with ceramic heads. This may lower the risk for thermal damage on periprosthetic bone. The ceramic heads deformed less during surgical implantation. This was not significant.

Densitas tulang alveolar pada penderita periodontitis kronis dan periodontitis agresif melalui radiografi

Objectives: The purpose of this study was to determine alveolar bone density in patients with chronic periodontitis and aggressive periodontitis through panoramic radiography . Material and Methods: The method used in this study was descriptive. This study was conducted on populations that met all criteria. The sampling method used was purposive sampling technique, so that 31 panoramic radiographs were diagnosed with chronic periodontitis and 7 panoramic radiographs were diagnosed with aggressive periodontitis. Results: The study showed that bone density in chronic periodontitis had an average of bony trabeculae 28.6% and marrow spaces 71.4% while bone density in aggressive periodontitis had an average bony trabeculae 20.2% and marrow spaces 79.8% Conclusion: Based on the results of the study it can be concluded that bone density in patients with chronic periodontitis and aggressive periodontitis has a low bone density value. The average bone density in patients with chronic periodontitis and aggressive periodontitis has different values, where the bone density in chronic periodontitis is greater than aggressive periodontitis.

The Effect of Tapered Abutments on Marginal Bone Level: A Retrospective Cohort Study

Background: Early peri-implant bone loss has been associated to long-term implant-prosthetic failure. Different technical, surgical, and prosthetic techniques have been introduced to enhance the clinical outcome of dental implants in terms of crestal bone preservation. The aim of the present cohort study was to observe the mean marginal bone level around two-part implants with gingivally tapered abutments one year after loading. Methods: Mean marginal bone levels and change were computed following radiological calibration and linear measurement on standardized radiographs. Results: Twenty patients who met the inclusion criterion of having at least one implant with the tapered prosthetic connection were included in the study. The cumulative implant success rate was 100%, the average bone loss was −0.18 ± 0.72 mm, with the final bone level sitting above the implant platform most of the time (+1.16 ± 0.91 mm). Conclusion: The results of this cohort study suggested that implants with tapered abutments perform successfully one year after loading and that they are associated with excellent marginal bone preservation, thus suggesting that implant-connection macro-geometry might have a crucial role in dictating peri-implant bone levels.