4th Postoperative Week Research Articles

The antibiotics supplemented bone cement improved the masquelet's induced membrane in a rat femur critical size defect model

BackgroundMasquelet technique is a two-stage surgical procedure used in the treatment of critical-size bone defects (CSD). Adding antibiotics to polymethylmethacrylate (PMMA) is still questionable to create higher quality induced membrane (IM). The aim of the study was to evaluate the effects of three antibiotic-supplemented cement, fusidic acid, teicoplanin, and gentamicin, on osteogenesis and IM progression applied to rat femur CSD model by comparing histopathological, biochemical, and immunohistochemical findings. MethodsTwenty-eight male rats were divided into four groups control, gentamicin (G), teicoplanin (T), and fusidic acid (FA). A 10 mm CSD was created in rat femurs. In the postoperative 4th week, intracardiac blood samples were collected for biochemical analysis of bone alkaline phosphatase (BALP), osteocalcin (OC), and tumor necrosis factor-alpha (TNF-α) levels. IMs obtained in secondary operation were fixed and prepared for histopathological scoring of membrane progression and immunohistochemical evaluation of rat-specific Transforming Growth Factor-Beta (TGF-β), Runt-related Transcription Factor 2 (Runx2), and Vascular Endothelial Growth Factor (VEGF) expressions. ResultsLevels of BALP and OC in serum didn't change among groups significantly while serum TNF-α levels significantly decreased in all antibiotic groups compared to the control group (P = 0.017). Histological scores of groups FA and T were significantly higher than those of groups Control and G (P = 0.0007). IMs of groups T and FA showed good progression while those of groups Control and G were also moderately progressed. A significant increase in TGF-β expression was observed in group G and FA (P = 0.001) while a significant increase in the expression of VEGF was observed in groups G and T compared to the control group (P = 0.036). ConclusionsThe bone cement impregnated with thermostable and safe antibiotics, gentamicin, fusidic acid, and teicoplanin can increase osteogenesis and support IM progression by increasing the expressions of TGF-β and VEGF. Anabolic effects of induced membranes used in the treatment of critical-size bone defects can be enhanced by antibiotic-supplemented PMMAs applied by altering the original technique.

Surgical outcome of endoscopic third ventriculostomy compared to ventriculoperitoneal shunt in non-communicating or obstructive hydrocephalus

Objectives: To assess and compare the effectiveness of Endoscopic Third Ventriculostomy over Ventriculoperitoneal shunt in terms of rate of revision in non-communicating or obstructive hydrocephalus at a tertiary care centre in a low-middle-income country. Materials and methods: A Prospective Cohort Study was conducted from January 2019 to December 2020 at PIMS/SZABMU, Islamabad, Pakistan. A total of 104 patients of either gender under the age of 12 years diagnosed with non-communicating/obstructive hydrocephalus were enrolled in this study. They were allocated into two equal groups of 52 by the lottery method. One group underwent Ventriculoperitoneal Shunt (Group I) and another group underwent Endoscopic Third Ventriculostomy (Group II). They received routine treatment of one-week postoperative prophylactic broad-spectrum antibiotics. They were discharged on the third postoperative day and were instructed for follow-up on the 4th, 12th and 24th postoperative week. Clinically, successful outcomes were defined as no event occurring during or after the surgery that could result in reoperation or any significant postoperative complication. Results: There were 55.8% males and 44.2% females in group I while 50.0% males and 50.0% females were in group II. The mean age of Group I was 0.89 years ± 1.5 SD while 2.3 years ± 2.8 SD in group II. During the procedure, the overall complication rate was 0% in group I and 4.1% in group II. In the 4th postoperative week, the overall complication rate was 5.9% in group I and 4.1% in group II. At the 12th postoperative week, the overall complication rate was 17.6% in group I and 2.0% in group II. On the 24th postoperative week, the overall complication rate was 9.8% in group I and none in group II. During the procedure, reoperation was needed in 0% in group I and 4.1% in group II. In the 4th postoperative week, reoperation was needed in 5.9% of patients in group I and 2.0% in group II. In the 12th postoperative week, reoperation was needed in 17.6% of patients in group I and 2.0% in group II. At the 24th postoperative week, reoperation was needed in 9.8% of patients in group I and none in group II. The overall mortality rate was 5.9% in group I and 4.1% in group II. Conclusion: Endoscopic Third Ventriculostomy procedure was found to be better than the Ventriculoperitoneal shunt in terms of reoperation and complication rate at the 4th, 12th and 24th week after the procedure in infants and children with non-communicating/obstructive hydrocephalus.

The effect of repeated flexion-based exercises versus extension-based exercises on the clinical outcomes of patients with lumbar disk herniation surgery: a randomized clinical trial

ABSTRACT Background Valuable impact of postoperative exercises on the clinical outcomes of patients with lumbar discectomy has been demonstrated. However, there is a lack of consensus on the best kind of postoperative exercises. This study aimed to evaluate the impact of the early postoperative flexion-based and extension-based exercises on the clinical outcomes of patients with lumbar discectomy. Methods In this single-blind randomized clinical trial (RCT), 90 subjects with lumbar discectomy were randomly assigned to three groups. The flexion-based and extension-based exercises were planned for the first and the second groups, respectively. The third group was considered as the control group. Subjects in the experimental groups started their exercise program at the end of the 6th postoperative week and continued exercises for 8 weeks. We used Visual analogue scale (VAS), Oswestry Disability Index (ODI), modified Biering-Sorensen test (mBST), and Trunk Flexion Endurance Test (TFET) to evaluate back pain, disability, back and abdominal muscle endurance, respectively. The outcomes were investigated before starting the exercises program as well as at the end of the study. Moreover, return to work was evaluated at the end of the study. Data were analyzed using descriptive and inferential statistics by SPSS-24 software. Results Our results showed that the VAS pain diminished in all the groups. However, this reduction was most in the McKenzie group (P < 0.001). Moreover, extension-based exercises reduced ODI more than other groups (P < 0.001). We found that extension-based and flexion-based exercises had more efficacy in increasing the back and trunk flexion endurance, respectively (P < 0.001). There was not a significant difference between the three groups in the term of returning to work (P = 0.06). Conclusions Both flexion-based and extension-based exercises could reduce postoperative back pain and disability. However, the impact of the extension-based program was more dominant. Moreover, these exercises could increase back and abdominal muscle endurance. Therefore, prescribing such low-cost home-based exercises could be very helpful for patients with lumbar discectomy.

EVALUATION OF EFFICACY OF BARBED SUTURES IN INTRAORAL WOUND CLOSURE

Background and Objective: Surgical knots though provides an anchoring function on suture line, but also present a potential source of infection. Knotless barbed sutures were designed to prevent knot-related complications. The aim of this study was to determine the safety, effectivity and longevity of unidirectional barbed sutures in intraoral wound closure. Materials and method: A non-randomised study involving 13 patients who required intraoral incisions for open reduction and internal fixation of mandibular fractures and alveoloplasty. Following the surgical procedures, wound closure was done by unidirectional barbed sutures. Outcome parameters that were measured were type of healing, erythema, wound discharge, wound dehiscence, necrosis and pus on 3rd and 7th post-operative day and 2nd and 4th post-operative week. Results: Statistically significant change in healing and erythema status was observed in the group (P value &lt; 0.001) across the timeline. No statistical significance was found for other parameters. Dehiscence of sutured wound was observed on the same day of the procedure in one patient. Suture extrusion was also noticed in one patient after 1st postoperative week. Conclusion: Knotless barbed sutures can be used without harm in wound approximation of intraoral incisions with no potentially harmful major or minor complications.

PreserFlo™ MicroShunt Combined with Phacoemulsification versus PreserFlo™ MicroShunt as a Standalone Procedure in Patients with Medically Resistant Open-Angle Glaucoma.

Purpose:To compare the efficacy and safety of PreserFlo™ MicroShunt (Santen, Osaka, Japan) combined with phacoemulsification to PreserFlo™ MicroShunt as a standalone procedure in eyes with moderate to advanced open-angle glaucoma.Methods:In an observatory, prospective, clinical study, 30 patients (30 eyes) with moderate to advanced angle glaucoma were allocated to either PreserFlo™ MicroShunt combined with phacoemulsification (15 eyes; Group A) or PreserFlo™ MicroShunt as a standalone procedure (15 eyes; Group B). The follow-up time of the study was 12 months.Results:Average intraocular pressure (IOP) at 12 months was 11.62 ± 1.6 mmHg in Group A and 13.8 ± 3.6 mmHg in Group B, which was significantly lower than baseline IOP (Group A: 23.47 ± 8.99 mmHg, P < 0.001; Group B: 23.4 ± 8.68 mmHg, P < 0.001). The absolute reduction of IOP within the 12 postoperative months was not significantly different between the two groups (P = 0.056). The number of the topical medications that were administered 12 months after ocular surgery was 0 in Group A and 0.6 ± 0.8 in Group B, compared to 3.13 ± 1.02 in Group A (P < 0.001) and 2.4 ± 1.45 in Group B (P = 0.004) at baseline. Phacoemulsification combined with PreserFlo™ MicroShunt significantly reduced the number of antiglaucoma agents after 12 months compared to the standalone procedure (P = 0.026). One eye in Group A was referred for bleb revision due to bleb fibrosis and a consequent acute postoperative rise in IOP. One eye in Group A required transscleral cyclophotocoagulation with MicroPulse® laser. One bleb revision was also necessary in Group B at the 4th postoperative week. Endothelial cell density did not significantly change over 12 months in either group (Group A: baseline, 2017.3 ± 346.8 cells/mm[2]; 12 months, 1968.5 ± 385.6 cells/mm[2]; P = 0.38; Group B: baseline, 2134.1 ± 382.6 cells/mm[2]; 12 months, 2094.4 ± 373.3 cells/mm[2], P = 0.42). The PreserFlo™ MicroShunt combined with phacoemulsification produced higher absolute success rates after 12 months in patients with moderate to advanced open-angle glaucoma than the PreserFlo™ MicroShunt as standalone procedure (Group A: 80% and Group B: 60%, P = 0.022).Conclusions:In eyes with moderate to advanced open-angle glaucoma, PreserFlo™ MicroShunt with or without phacoemulsification is effective in reducing IOP and the number of the antiglaucoma agents with a very small incidence of complications and subsequent glaucoma surgeries. However, adding phacoemulsification to PreserFlo™ MicroShunt successfully reduces IOP without the need for ongoing topical medications as are needed after the standalone procedure.

Continuous passive motion not affect the knee motion and the surgical wound aspect after total knee arthroplasty

BackgroundThis study aimed to assess whether use of continuous passive motion (CPM) could improve range of motion in patients after total knee arthroplasty (TKA), if it could affect the surgical wound aspect (SWA) and if it could influence on pain management after TKA.MethodsWe randomized 210 patients in two groups, 102 patients in the CPM group, who received a standard rehabilitation protocol together with CPM application; and 108 patients in the no-CPM group, without CPM. Variables as knee motion (flexion, extension, range of motion) and pain were measured before surgery, on the 1st, 2nd and 3rd postoperative day, and in the 2nd, 6th, 12th and 24th postoperative weeks following TKA. The SWA was determined by the “surgical wound aspect score” (SWAS) in the next 48 h after surgery. This scale analyzes swelling, erythema, hematoma, blood drainage and blisters.ResultsThere was an improvement in the knee motion over the course of follow-up in both groups, without significant difference in flexion parameter. We found no significant differences in the total score of SWA, except for hematoma, with less severity in the CPM group. Furthermore, we found no differences in the others SWAS parameters and pain.ConclusionsThe application of CPM does not provide benefit to our patients undergoing TKA in terms of either improved flexion mobility or decreased pain. No relationship was found between the use of CPM and the global score of SWA following a TKA, except for a decrease in hematoma appearance.

Experience with Resorbable Plates for Fixation of Mandible Fracture. A Prospective Study of 10 Cases.

Aim:This study aims to evaluate the efficacy of resorbable plates for the fixation of mandible fracture.Materials and Methods:10 cases of fracture mandible were treated with resorbable plates using the Inion CPS system. Patients were evaluated during their entire hospital stay and recalled on 1st, 4th, and 8th postoperative weeks. A thorough evaluation was done at the recall visits for any surgical and postoperative complications such as infection, malocclusion, neural abnormalities, wound or suture dehiscence, segmental mobility, foreign body reaction, and pain on biting. Bite force measurements were taken to evaluate the return of function.Results:Clinical union of the fracture was noted at the 8th week follow-up examination for all cases. There were swelling and pain at the operated site at 8th week follow-up for one patient, which was managed conservatively. The mean bite force was recorded for different regions and it increased over the entire follow-up period progressively.Conclusion:These plates and screws are an essential tool in the treatment of mandibular fractures owing to benefits such as biodegradability, biocompatibility, and the ability to be eliminated via the body's natural processes.

Effect of single-dose locally applied lactoferrin on autograft healing in peri-implant bone in rat models

Immediate dental implant installation into fresh extraction sockets has become a common surgical technique and yields successful clinical results. In addition, complete contact may not be possible with this procedure cause of defects between the bone wall and the implant surface. Therefore, different graft materials have been used in the literature to increase the peri‑implant bone volume. The aim of the present study was to evaluate the effect of single-dose and locally applied lactoferrin on autograft healing in peri‑implant area and bone implant contact value. Twenty-four Sprague-Dawley rats were included in this study. Firstly, a trephine drill was used for creating a cylindrical bony defects (6.5 mm in diameter and 3 mm in depth) under sterile saline irrigation in the lateral side of the femur. Subsequently, implant beds –2.5 mm diameter and 6 mm depth – were prepared in the middle of each defect with special implant drills. All of the implants were installed and primary stability was achieved. Rats were randomly divided into 3 groups (n = 8 each): Group-1 had empty defects, Group-2 had defects filled with autograft, and Group-3 had defects filled with autograft and lactoferrin solution (100 μg/ml) combination. All of the rats were sacrificed at postoperative 4th week and samples were analyzed with micro-computed tomography, histomorphometry and immunohistochemistry respectively. It was found that Group 3 had the least area of fibrous tissue (6.75±0.83mm2) according to the other 2 groups (p<0.001). On the other hand, Group 3 had the highest osteoblast number (25.50±3.29), osteoclast number (21.25±1.03), newly formed bone area (20.50±1.30 mm2), total healing area (22.62±0.93 mm2), defect closure rate (80.37±1.40%), bone implant contact value (23.2%±0.6%), and percentage bone volume (18.2%±0.3%) (p<0.001). Matrix metalloproteinase-3 expression was found to be highest in Group 3 by immunohistochemistry analysis. In this study it was observed that the results of the different analysis techniques supported each other. According to these findings it can be stated that a single-dose and locally applied lactoferrin solution plays an important role in the autograft healing in peri‑implant area and increasing bone implant contact value. These findings will shed light on further clinical studies of implant osseointegration.

Reconstruction osseuse : évaluation subjective et analyse objective basées sur les radiographies numériques conventionnelles – analyse rétrospective

BackgroundVarious approaches have been used to evaluate callus stiffness in distraction osteogenesis. This assessment becomes even more critical as inadequate corticalization and premature removal of the frame lead to bending, refracture, and loss of length. This study aimed to verify the objective Pixel Value Ratio (PVR) and define an evaluation scheme to assess callus tissue development during internal and external bone lengthening. HypothesisThere are no differences between subjective parameters and objective evaluation for external and internal bone lengthening. Patients and methodsWe included 24 patients in this retrospective study, treated by distraction osteogenesis of the lower limb. Ten patients were treated with external ring fixators and 14 with intramedullary lengthening devices. The minimum distraction distance was 3cm. Callus tissue was evaluated with the PVR, using digital x-rays during and after treatment. We combined this method with subjective evaluation parameters, including the continuity, signal intensity, and the regeneration tissue's homogeneity, presented in the X-ray Evaluation System for Distraction Osteogenesis (XESDO). ResultsThe subjective evaluation showed an increase of continuity and signal-intensity between 4th postoperative weeks and complete healing with significant differences between the external and internal groups for homogeneity only after four weeks and for all parameters at 3C (p<0.05). The PVR showed an increase during consolidation with values between 0.7 and 1.0 for both groups with almost perfect interobserver agreement. Significant lower values were found in the anterior tibial cases. ConclusionPVR appears to be a practical tool for radiological evaluation of callus tissue development. In combination with the newly introduced XESDO and the surgeon's experience, these methods can be helpful for decisions during all phases of distraction osteogenesis. It is important for adapting alignment or distraction-rate, as various potential complications can be detected early. However, further studies are necessary to assess the image-based determination of callus tissue stability. Level of evidenceIII; cohort study.

Bone reconstruction: Subjective evaluation and objective analysis based on conventional digital X-rays – a retrospective evaluation

BackgroundVarious approaches have been used to evaluate callus stiffness in distraction osteogenesis. This assessment becomes even more critical as inadequate corticalization and premature removal of the frame lead to bending, refracture, and loss of length. This study aimed to verify the objective Pixel Value Ratio (PVR) and define an evaluation scheme to assess callus tissue development during internal and external bone lengthening. HypothesisThere are no differences between subjective parameters and objective evaluation for external and internal bone lengthening. Patients and methodsWe included 24 patients in this retrospective study, treated by distraction osteogenesis of the lower limb. Ten patients were treated with external ring fixators and 14 with intramedullary lengthening devices. The minimum distraction distance was 3cm. Callus tissue was evaluated with the PVR, using digital X-rays during and after treatment. We combined this method with subjective evaluation parameters, including the continuity, signal intensity, and the regeneration tissue's homogeneity, presented in the X-ray Evaluation System for Distraction Osteogenesis (XESDO). ResultsThe subjective evaluation showed an increase of continuity and signal-intensity between 4th postoperative weeks and complete healing with significant differences between the external and internal groups for homogeneity only after four weeks and for all parameters at 3C (p<0.05). The PVR showed an increase during consolidation with values between 0.7 and 1.0 for both groups with almost perfect interobserver agreement. Significant lower values were found in the anterior tibial cases. ConclusionPVR appears to be a practical tool for radiological evaluation of callus tissue development. In combination with the newly introduced XESDO and the surgeon's experience, these methods can be helpful for decisions during all phases of distraction osteogenesis. It is important for adapting alignment or distraction-rate, as various potential complications can be detected early. However, further studies are necessary to assess the image-based determination of callus tissue stability. Level of evidenceIII; cohort study.

Comparison of Functional and Radiological Outcomes of Transverse Patellar Fractures Fixed with Tension Band Fixation Using Cannulated Screws and Kirschner Wires: A Prospective Randomized Study.

To compare functional and radiological outcomes of transverse patella fractures treated with tension band wiring using either two 4.5mm cannulated screws or Kirshner wire. This is a non-blinded prospective randomized study comprising of two groups (n = 30 each) with closed transverse patella fractures treated with tension band wiring using Kirschner wire (K wire group) and two 4.5mm cannulated screws (CCS group). Outcomes measured were radiological union, Knee Society score, range of motion and post-operative complications. The CCS group showed a statistically significant higher range of motion than K wire group for each follow up (p < 0.001 in flexion and p < 0.005 in extension). A statistically significant higher percentage of patients in the CCS group showed signs of union at 6th and 12th post-operative week (p = 0.001 and 0.011 respectively) but no difference at 24th post-operative week (p = 0.313). The rate of hardware complications was significantly higher in K wire group (p = 0.001). No significant difference was noted in in the Knee society score and post-operative complications between the groups. This study concludes that the fixation of closed transverse patella fractures using two 4.5mm cannulated screws is allows a faster rate of union, a better knee range of motion and lesser hardware complications as compared to Kirschner wires. However more studies with larger sample sizes and longer follow up are required.

A comparative study of post-operative astigmatism in superior versus superotemporal scleral incisions in manual small incision cataract surgery in a tertiary care hospital

Background: In developing countries, manual small incision cataract surgery is a better alternative and less expensive in comparison to phacoemulsification and thus the incision is an important factor causing high rates of postoperative astigmatism resulting into poor visual outcome. Thus, modifications to the site of the incision is needed to reduce the pre-existing astigmatism and also to prevent postoperative astigmatism. Modification to superotemporal incision relieves pre-existing astigmatism majorly due to its characteristic of neutralizing against-the-rule astigmatism, which is more prevalent among elderly population and thus improves the visual outcome. Aims: To study the incidence, amount and type of surgically induced astigmatism in superior and superotemporal scleral incision in manual SICS. Methodology: It is a randomized, comparative clinical study done on 100 patients attending the OPD of Ophthalmology at a tertiary care hospital, with senile cataract within a period of one year and underwent manual SICS. 50 of them chosen randomly for superior incision and rest 50 with superotemporal incision. MSICS with PCIOL implantation were performed through unsutured 6.5 mm scleral incision in all. Patients were examined post-operatively on 1st day, 7th day, 2nd week and 4th week and astigmatism was evaluated and compared in both groups. Results: It is seen that on postoperative follow up on 4th week, 77.78% of the patients with ATR astigmatism who underwent superior incision had increased astigmatism whereas, only 13.63% of the patients with ATR astigmatism who underwent supero-temporal incision, had increased astigmatism but 81.82% had decreased ATR astigmatism. However, 77.78% of the patients with preoperative WTR astigmatism who underwent supero-temporal incision, had increased astigmatism, whereas 44.45% of the patients with WTR astigmatism preoperatively, had increased astigmatism in contrast to 50% had decreased amount of astigmatism. It is also seen that the supero-temporal incision group had more number of patients (78%) with visual acuity better than 6/9 at 4th postoperative week than superior incision group (42%). Conclusion: This study concludes that superior incision cause more ATR astigmatism postoperatively whereas superotemporal incision causes lower magnitude of WTR astigmatism, which is advantageous for the elderly. Besides superotemporal incision provides better and early visual acuity postoperatively.

Endonasal Endoscopic Dacryocystorhinostomy with and Without Stents-A Comparative Study.

The study aims to compare the outcomes of endonasal endoscopic dacryocystorhinostomy (DCR) with and without nasolacrimal stents. A prospective randomized comparative study involving fifty patients, divided into two groups of 25 patients each. Group A consists of patients who underwent endoscopic DCR with silicon stent and group B consists of patients who underwent endoscopic DCR without stent. Patients were regularly followed up at 1st week, 6th week, 10th week and at the end of 5th month postoperatively. The silicone stents were removed at 6th postoperative week. Using statistical analysis results between the two groups were compared. Post-operative improvement in nasolacrimal duct obstruction and epiphora was seen in both the groups. Age of the patients ranged from 18 to 69years with most of the patients in the age group of 40 to 49years (46% N = 23, 12 in group A and 11 in group B). 88% of the patients were females. (N = 44, 21 in group A and 23 in group B) and 12% were males (N = 6, 4 in group A and 2 in group B). The disease was more commonly observed on the left side with 72% of the cases (N = 36, 19 in group A and 17 in group B) and 28% (N = 14, 6 in group A and 8 in group B) on the right side. In group A, (En DCR with silicone stent) 96% of the cases were successful while 4% resulted in failure whereas in group B (En DCR without stent) 92% of the cases were successful while 8% resulted in failure. Endoscopic DCR is simple and safe method. It is minimally invasive procedure as it is a direct approach to the sac. Cosmetically it is acceptable as there is no external scar. Endoscopic dacryocystorhinostomy with canalicular silicone intubation for shorter duration (6weeks) is a safe and successful procedure for the treatment of nasolacrimal duct obstruction. Close follow up immediately after surgery is needed to reduce the failure rate. Regular post-operative follow up is necessary and any defect like synechia and granulation tissue formation can be released at follow up period thus increasing the success rate. En DCR has a good success rate with and without stenting of 96% and 92% respectively.

Clinical, functional and radiological outcomes of volar locked plating of distal radius fracture: A prospective study

Background: The fracture of lower end radius is the most common fracture of the upper extremity encountered in practice and constitutes 10 to 20% of all the fractures and 75% of all forearm fractures. In spite of various new advances, closed reduction and cast immobilization has been the mainstay of treatment of these fractures, but malunion of fracture and subluxation /dislocation of distal radioulnar joint resulting in poor functional and cosmetic results is the usual outcome. Recently, the volar locked plate osteosynthesis is considered as the “gold standard” in treatment of ‘unstable’ distal radius fractures. The present study proposed to evaluate the role of volar locking plate fixation in the management of intra-articular and extra-articular volar fractures of distal end radius and to evaluate the clinical, functional and radiological outcomes.Aim and Objectives: To study the improvement in clinical, functional and radiological outcomes of volar locked plate fixation in a distal end radius fracture.Materials and Methods: A prospective study was undertaken in a Tertiary Hospital from September 2016 to September 2018, 30 patients (age >20 yrs) with volar fracture of lower end of radius i.e. AO types A 2.3, B 3.1, B 3.2, B 3.3 operated with volar locked plating. The patients were followed up at 2nd, 6th, 12th and 24th postoperative weeks. Radiological & clinical, functional outcomes were assessed by using Stewart score & PRWE (Patient–rated wrist evaluation questionnaire) score respectively. Data collected of these 30 patients were statistically analysed using ANOVA chi – square test.Results: Clinical and Functional outcome by Patient Rated Wrist Evaluation scoring system shows maximum no. of patients come in Good and Excellent grading i.e. 17(56.7%) and 8(26.7%) out of 30 patients, along with this 1(3.3%) Fair and 4(13.3%) Poor result. Radiological outcome by Stewart I scoring system is Maximum no. of cases shows Good and Excellent results i.e. 20(66.7%) and 6(20%) out of 30 patients. With this 1(3.3%) Fair and 3(10%) Poor result.Conclusion: Open reduction and internal fixation with volar locked plating has satisfactory functional and radiological outcome with minimal complications and thus it is an excellent modality to treat volar fractures of distal end radius.

English

BACKGROUND Phacoemulsification is a common surgery for cataract. The endothelium comprises of hexagonal cells which in single layer is essential for maintaining the transparency of the cornea. We wanted to compare endothelial cell density (ECD), central corneal thickness (CCT), coefficient of variability, and hexagonality of endothelial cells before and after phacoemulsification surgery. we also wanted to evaluate the endothelial cell loss after phacoemulsification surgery. METHODS A rural hospital-based prospective observational study with 120 patients was conducted in a hospital based setting utilising the data of patient’s eye by considering inclusion and exclusion criteria, before and after phacoemulsification surgery by using noncontact specular microscope. RESULTS The mean endothelial cell density significantly decreased postoperatively at day one, 4th week, 12th week. The mean central corneal thickness increased significantly at postoperative day one, then subsequently decreased at postoperative 4th week and 12th week (P value = 0.0001), but never reached the preoperative value. There was a significant change in coefficient of variation and hexagonality postoperatively (P value = 0.0001). CONCLUSIONS The primary result is the change in corneal endothelial cell density (cells per square millimetre of the corneal surface) which is decreased, and the central corneal thickness calculated in micro meter is increased. As endothelial cells do not replicate, to reimburse cell loss there are changes in coefficient of variation and hexagonality after phacoemulsification surgery. KEY WORDS Corneal Endothelial Cell Density, Central Corneal Thickness, Coefficient of Variation, Hexagonality, Phacoemulsification, Specular Microscope

Does Costal Cartilage Resection Reduce Lung Volume ? (An Experimental Stereological Study)

Background: Surgical treatment of chest wall deformities is done with costal cartilage resection in selected patients in adolescence. In this study, we evaluated the effect of costal cartilage resections on the lung volume by using computed tomography with stereologically. Methods: In this study, sixteen 4-weeks-old New Zealand rabbits were employed. Young subjects were preferred to evaluate the effect of the operation on the growth process. In order to avoid postoperative complications, only 2 costal cartilage resection was performed. The surgical group was resected to the right 4 and 5 costal cartilages (n = 8). The group that was not operated was accepted as the control group (n=8). The growth of the subjects was followed. Computed thorax tomography (CTT) scans of all animals were performed preoperatively and at the 4th postoperative week. Estimation of pre- and postoperative lung volumes was performed with the Cavalieri principle. Results: In the control group followed up during growth, bilateral lung volume was increased (15.75% and 20.62% respectively right and left lungs). In the surgical group, both the surgical side and the opposite lung volume decreased after costal cartilage resection (20.09% and 1.07% respectively right and left lungs). Conclusions: Even though the number of resected cartilage was limited, total lung volume decreased after costal cartilage resection. In the treatment of chest wall deformities, costal cartilage resection should be considered as the last option in children.

Bite force measurement in maxillofacial trauma – A clinical prospective study

Introduction: Maxillofacial fractures not only cause a change in the skeletal architecture (anatomical) but also lead to changes in the masticatory apparatus (functional). Masticatory function refers to the ability to chew without any interference or pain. The major determinants of this is the range of mandibular motion, maximum occlusal forces, and the activity of the masticatory muscles. This function is affected in maxillofacial trauma and also pathological injuries to the jaws. Bite force measurements are an excellent criteria for the assessment of masticatory efficiency. The purpose of this study was to assess the effect of maxillofacial fractures on the bite forces of patients treated for such fractures. Materials and Methods: 65 patients divided into 7 groups based on the kind of maxillofacial fracture. All the cases underwent ORIF. Bite force were measured on the immediate post-operative period, 1st , 4th and 12th post-operative week. The bite force instrument (transducer) was positioned between the antagonizing cusps in the region of Left First Molar and Right First Molar. Results: At the end of the 3rd post-operative week, all the groups showed a statistically significant increase in the bite force measurement as compared to the immediate post-operative bite force recording. Conclusion: Thus we conclude by saying that our study provides a basis for similar studies with a longer follow up period and larger sample size in order to assess the different kinds of maxillofacial trauma and its effect on bite force. Keywords: Bite force, Bite force device, Occlusal load, Maxillofacial trauma, Lefort fractures, Restoration of bite force.

Biliary diversion increases resting energy expenditure leading to decreased blood glucose level in mice with type2 diabetes.

Aims/IntroductionType 2 diabetes mellitus is a group of metabolism abnormalities in carbohydrates and energy. Our aim was to investigate resting energy expenditure (REE) and blood glucose changes after biliary diversion in mice with diabetes.Materials and MethodsMale mice with diabetes were randomly divided into biliary diversion and sham groups. REE was detected by indirect calorimetry, the levels of fasting blood glucose, total bile acids and triiodothyronine were analyzed. After mice were killed, the weight amount of brown adipose tissue (BAT) and gastrocnemius was measured, and the expression level of G protein‐coupled bile acid receptor and type 2 iodothyronine deiodinase in BAT and gastrocnemius were examined.ResultsThe two groups of mice were pair‐fed, the bodyweights (P < 0.001) and the fasting blood glucose level (P < 0.001) in the biliary diversion group significantly decreased 24 weeks after surgery. The intraperitoneal glucose tolerance test (P = 0.035) and oral glucose tolerance test (P = 0.027) showed improvement in glucose tolerance after surgery. The REE level significantly increased 24 weeks after surgery (P = 0.005), the levels of total bile acids (P = 0.014) and triiodothyronine (P < 0.001) increased at the 24th postoperative week. The weight ratio of BAT (P = 0.038) and gastrocnemius (P = 0.026) in the biliary diversion group were higher than that in the sham group. The expression of G protein‐coupled bile acid receptor in BAT (P < 0.001) and gastrocnemius (P = 0.003) were upregulated after surgery, and the type 2 iodothyronine deiodinase expression also increased in BAT (P = 0.015) and gastrocnemius (P = 0.015).ConclusionsThe REE level increased and the glucose metabolism improved in mice with diabetes after biliary diversion.

Outcome of modified rectangular 3-snip punctoplasty with mini-Monoka stent and mitomycin-C

Purpose The aim of this study was to evaluate the efficacy of combining mitomycin-C (MMC) with modified rectangular 3-snip punctoplasty and mini-Monoka stent to treat punctal stenosis.Design This is a prospective interventional case series.Patients and methods The study included 62 eyes of 31 patients diagnosed with epiphora secondary to punctal stenosis who received modified rectangular 3-snip punctoplasty with mini-Monoka stent and MMC in their right eyes (Rt eye group) and modified rectangular 3-snip punctoplasty with mini-Monoka stent only in their left eyes (Lt eye group). Epiphora, punctal opening, and tear meniscus height (TMH) were evaluated and compared with the preoperative data in both groups. The main outcome measures were epiphora, punctal opening, and TMH.Results A total of 17 (54.8%) patients were females, with a mean age of 58.4±5.1 years. No surgical complications were reported. Epiphora and TMH were improved, with a functional success of 90.3% in the Rt eye group and 87.1% in the Lt eye group, as compared with the preoperative status (P<0.001). The punctum remained open, with anatomical success achieved in 29 (93.5%) eyes in the Rt eye group and in 28 (90.3%) eyes in the Lt eye group (P<0.03). Moreover, the TMH and punctal grading were significantly better in the Rt eye group compared with Lt eye group during the 12th and 24th postoperative week follow-up visits (P<0.05).Conclusion MMC proved to be an efficient and safe therapeutic adjuvant in the armamentarium of oculoplastic surgeons to treat punctal stenosis.

Reduced Bone Neoformation in Smoking Rat’s Calvaria Grafted with Bone Ceramic

The impact of cigarette smoke on bone grafts in implantodontics has been discussed in the scientific literature. The present study aimed to evaluate bone repair in calvaria of rats after the performance of critical bone defects and graft of bone ceramic biomaterial in animals exposed or not to cigarette smoke. Bone defects of 5mm in diameter were made in parietal bone. Each defect was filled with Bone Ceramic biomaterial. Twenty rats were used and divided into 2groups: test, consisting of 10rats exposed to cigarette smoke; and a control group, consisting of 10rats not exposed to cigarette smoke. The animals were euthanized in the 4th postoperative week and bone tissue samples were extracted to perform the histometric analysis. The test group showed less bone neoformation, with statistical significance (p&lt;0.05) when compared to the control group. We conclude that cigarette smoke had a negative influence on bone neoformation.