Basis For Surgical Intervention Research Articles

Comparative Effectiveness of Cartilage Repair With Respect to the Minimal Clinically Important Difference

Background: Recent studies demonstrated a 5% increase in cartilage repair procedures annually in the United States. There is currently no consensus regarding a superior technique, nor has there been a comprehensive evaluation of postoperative clinical outcomes with respect to a minimal clinically important difference (MCID). Purpose: To determine the proportion of available cartilage repair studies that meet or exceed MCID values for clinical outcomes improvement over short-, mid-, and long-term follow-up. Study Design: Systematic review and meta-analysis. Methods: A systematic review was performed via the Medline, Scopus, and Cochrane Library databases. Available studies were included that investigated clinical outcomes for microfracture (MFX), osteoarticular transfer system (OATS), osteochondral allograft transplantation, and autologous chondrocyte implantation/matrix-induced autologous chondrocyte implantation (ACI/MACI) for the treatment of symptomatic knee chondral defects. Cohorts were combined on the basis of surgical intervention by performing a meta-analysis that utilized inverse-variance weighting in a DerSimonian-Laird random effects model. Weighted mean improvements in International Knee Documentation Committee (IKDC), Lysholm, and visual analog scale for pain (VAS pain) scores were calculated from preoperative to short- (1-4 years), mid- (5-9 years), and long-term (≥10 years) postoperative follow-up. Mean values were compared with established MCID values per 2-tailed 1-sample Student t tests. Results: A total of 89 studies with 3894 unique patients were analyzed after full-text review. MFX met MCID values for all outcome scores at short- and midterm follow-up with the exception of VAS pain in the midterm. OATS met MCID values for all outcome scores at all available time points; however, long-term data were not available for VAS pain. Osteochondral allograft transplantation met MCID values for IKDC at short- and midterm follow-up and for Lysholm at short-term follow-up, although data were not available for other time points or for VAS pain. ACI/MACI met MCID values for all outcome scores (IKDC, Lysholm, and VAS pain) at all time points. Conclusion: In the age of informed consent, it is important to critically evaluate the clinical outcomes and durability of cartilage surgery with respect to well-established standards of clinical improvement. MFX failed to maintain VAS pain improvements above MCID thresholds with follow-up from 5 to 9 years. All cartilage repair procedures met MCID values at short- and midterm follow-up for IKDC and Lysholm scores; ACI/MACI and OATS additionally met MCID values in the long term, demonstrating extended maintenance of clinical benefits for patients undergoing these surgical interventions as compared with MFX.

Morphology of Coronary Ostia in Domestic Shorthair Cat.

Diagnosis and treatment of heart diseases due to changes in the coronary vascularization need a detailed knowledge on the morphology and possible variations of the aortic valves and coronary ostia. This study was performed to clarify details on morphology of these structures in domestic cats. The tricuspid aortic valve was examined in 65 domestic shorthair cats. The location of coronary ostia was determined either inferior to (26 and 20%, left and right coronary ostium - LCO and RCO), at (65 and 66%) or superior to the intercommissural line (9 and 14%). In 13 cats (20%), accessory ostia were found either for left, right or both coronary arteries (LCA and RCA). Their position varied between specimens. They were located beyond the main ostium, at its edge, or inside just below the edge. In one cat, no main trunk of the LCA was found. In one cat, two accessory ostia next to the RCO were observed. Coronary ostia in cats show anatomical variants and morphological anomalies. This study provides basic data useful for, for example, angiography performed for diagnosis of cardiac diseases and as a basis for surgical interventions.

Dynamic Assessment of Hip Fracture under Different Impact Configurations: An Explicit Dynamic Analysis Approach

Dropping the hip causes stress transfer in the femur. Understanding stress transfer during dropping of the hip is very essential for the surgery .In this study, two computational models are constructed and used to simulate two hip fall scenes. We employ explicit dynamics analysis method to explore dynamic damage mechanism of hip joint, providing biomechanical basis for surgical intervention. The simulation results show that the stress continues to increase in the beginning and reach a maximum during dropping. In scene one, high stresses were presented on the femoral neck when the trochanter impacted the ground, and they were presented on the femoral trochanter when the ilium impacted the ground. The peak stresses were greater than yield point, the neck and trochanter were broken. In scene two, high stresses were presented on the femoral head when the distal femur impacted hit the ground, and they were presented on the femoral neck and shaft when the ilium rebounded from the ground. The later stresses were greater than yield point, the femoral neck and shaft were broken.

P102 Upper extremity kinematic analysis as a basis for surgical intervention: an OPBL case report

This study defines and evaluates a non-invasive technique that will identify a spasm as an uncommanded movement (U) from a normally commanded movement (C). Upper arm function during a tracking task is recognized as non-linear and characterized by a phase plane with acceleration (second derivative of stick position) plotted on the ordinate and velocity (first derivative of stick position) plotted on the abscissa. Am acceleration time constant (τA) is defined as (VAAM) where AM is the maximal acceleration and VA is the velocity at AM. A deceleration time constant (τD) is also defined as (VDDM), where DM is the maximal deceleration and VD is the velocity at DM. Ten spastic subjects (S) were categorized into three groups of mildly spastic (M), intermediately spastic (I), and highly spastic (H) which were compared to five normal subjects (N). The results indicate that for C and U, both VA and AM are significantly lower for S at all three levels as compared to N. τA is significantly higher for M and I as compared to N. Both VD and τD are significantly higher for S at all three levels when compared to N, DM is significantly lower for S at all three levels of S when compared to N. Finally, AM and τA significantly differentiate C vs U for M. VA and τD significantly differentiate for I. VA, AM as well as DM, τD significantly differentiate for H. The physical significance of these results is discussed with respect to the time course and magnitude of net muscle moment (M), and the reversal of the agonist-antagonist relationship during the acceleration and deceleration phases. Finally, a spasm identification algorithm is proposed.

Hernia diafragmática congénita en recién nacidos

With the aim of becoming acquainted with some characteristics of newborns as bearers of congenital diaphragmatic hernia (HDC), to determine lethality on the basis of surgical intervention (SI) timing, and predict the survival of this patients according the relation between the PaCO 2 and the IVM at the moment of the surgery, 38 neonates hospitalized in the Neonatology Unit of Guillermo Grant Benavente Hospital have been retrospectively studied. Surgery was perfomed en thirty neonates. Thirteen of them were operated before 24 hours of birth, death occuring in 61,5% of them. The remaining seventeen were operated as soon as their hemodynamics and breathing had been stabilized. Death occurring in 41,2%. Upon surgery, seventeen neonates were placed in square B of Bohn’s diagram obtaining a 70,5% survival rate; four neonates in square A with 50% survival and six in square C with 100% mortality. The mortality in our series was 60,5%. These data suggests that the survival rate could be greater in neonates whose hemodynamics and breathing had been previously stabilized. The optimun timing for surgical intervention should be as soon as they had been placed in Bohn’s square B.

BLOOD FLOW IN ARTERIES

▪ Abstract Blood flow in arteries is dominated by unsteady flow phenomena. The cardiovascular system is an internal flow loop with multiple branches in which a complex liquid circulates. A nondimensional frequency parameter, the Womersley number, governs the relationship between the unsteady and viscous forces. Normal arterial flow is laminar with secondary flows generated at curves and branches. The arteries are living organs that can adapt to and change with the varying hemodynamic conditions. In certain circumstances, unusual hemodynamic conditions create an abnormal biological response. Velocity profile skewing can create pockets in which the direction of the wall shear stress oscillates. Atherosclerotic disease tends to be localized in these sites and results in a narrowing of the artery lumen—a stenosis. The stenosis can cause turbulence and reduce flow by means of viscous head losses and flow choking. Very high shear stresses near the throat of the stenosis can activate platelets and thereby induce thrombosis, which can totally block blood flow to the heart or brain. Detection and quantification of stenosis serve as the basis for surgical intervention. In the future, the study of arterial blood flow will lead to the prediction of individual hemodynamic flows in any patient, the development of diagnostic tools to quantify disease, and the design of devices that mimic or alter blood flow. This field is rich with challenging problems in fluid mechanics involving three-dimensional, pulsatile flows at the edge of turbulence.

New approaches to the management of severe acute pancreatitis

A recent experience with seventy-seven patients admitted to Boston City Hospital for acute pancreatitis permitted us to identify thirteen patients (17 per cent) whom we diagnosed as having severe protracted acute pancreatitis. These alcoholic patients obviously had fulminant pancreatitis similar to that reported by others in two instances and pancreatic abscesses in two additional instances, but nine of the patients did not fulfill the criteria usually used by others as a basis for surgical intervention. Specific preoperative diagnosis was obtained in these patients by the aggressive use of endoscopic cannulation of the pancreatic ducts, which documented the presence of surgically correctable lesions. These patients had sustained significant malnutrition, which was corrected only by protracted therapy extending an average of two months and involving all modalities currently available for nutritional support of the severely ill patient. After proper preoperative identification of a specific lesion and correction of the malnutrition, the eleven patients without fulminant disease were operated on with no deaths or significant complication. Nine of the patients had elective procedures, which included six distal pancreatectomies and one total pancreatectomy. Thus, severe protracted acute pancreatitis can be identified, and once categorized, it can have therapeutic implications.

THE ADRENALS AND EXPERIMENTAL PANCREATIC DIABETES

The etiology and course of diabetes mellitus have been associated with adrenal function by various authors since Zuelzer 1 proposed the view that a mutual antagonism exists between the adrenals and the pancreas. He said he believed that the glycosuria which follows pancreatectomy is due to the unchecked diabetogenic action of epinephrine secreted from the adrenals in the absence of the antagonistic action of internal secretion of the pancreas. More recently the supposed relationship of the adrenals to diabetes and to other diseases has become the basis for surgical intervention or roentgen irradiation of the adrenals in clinical practice. In view of the fact that these procedures involve possible irreparable damage to the indispensable adrenal cortex as well as to the less essential medulla, they should be based on physiologic premises that have indisputable experimental support, or else they should be condemned as too dangerous for life and health to