Cm2 In Group Research Articles

Aesthetic and Functional Evaluation of Abdominal Contouring Using Lipo-Abdominoplasty versus Lipo-Abdominoplasty with TULUA Procedure: A Comparative Clinical Study

Abstract Background Lipoabdominoplasty techniques may be followed by a wide range of complications as flap necrosis, wounddehiscence, surgical site infection, epigastric bulging, malpositioned umbilicus, high transverse scar and seroma formation. Villegas in 2014 introduced the TULUA abdominoplasty to improve the aesthetic outcome and to avoid the many associated complications mentioned. The objective of this study is to compare the aesthetic and functional outcomes between the traditional lipoabdominoplasty and TULUA abdominoplasty. Methods in this prospective comparative clinical study, sixty adult women with excess subcutaneous abdominal fat and skin laxity after repeated pregnancies with mild to moderate degree of diastasis of recti were included. The patients’ ages ranged between 28-55 years, their BMI scores were 25-35 kg/m2. Group A (30 patients) underwent lipoabdominoplasty while group B (30 patients) underwent TULUA abdominoplasty. The patients were followed up for a minimum of 6 months where the comparative study included aesthetic results as regards the abdominal contouring using clinical outcome scaling systemin addition to functional aspects assessing anatomical features, changes in anterior abdominal wall and finally the complication rate between both techniques. Results The average total liposuction aspirate volume of the abdomen was 2400 ml in group A, while in group B, the average volume was 3500 ml. The mean surface area of vertical plicature measured intraoperatively was 211.93 (±54.66) cm2 in group A, while in group (B) transverse plicature surface area was 369.47(±84.22) cm2. The increase in intra-abdominal pressure IAP after plication and skin closure in group A was 7.93±1.26 cmH2O; while for group B there was a highly significant increase by 9.87±1.01 cmH2O. Flap sloughing was seen in 4 cases(13.3%), wound dehiscence 2 cases (6.6%) seroma in 3 cases(10%) for group A,conversely no cases reported flap necrosis, wound dehiscence or seroma that need to be aspired in group B. The aesthetic outcomes were evaluated using a 5 points likert scale system through three indicators, f or group A,an overall result that was 4.50 ± 0.87, umbilical appearance 4.61±0.73, and scar quality 4.35 ± 0.82; On the other hand group B showed overall result 4.53 ± 0.71, umbilical appearance 4.52 ± 0.82, and scar quality 4.43 ± 0.87. Conclusions TULUA procedure is a safe, reproducible shift in abdominoplasty, with fewer complications to occur.

The role of collagen dressings in the complex treatment of diabetic foot ulcers

The prevalence of diabetes mellitus (DM) in the population aged 20–79 years has reached more than half a billion people, representing about 10.5 % of the adult population on the planet. The risk of developing diabetic foot ulcers ranges from 19 to 34 % with a recurrence rate of 65 % within 5 years.The aim of the study: to evaluate the efficacy of dressings containing lyophilized collagen solution in the complex treatment of chronic diabetic foot ulcers.Materials and methods. 101 patients with diabetic foot ulcers (degree of foot lesions I–II according to Wagner) were under observation: in I (main) group — 52 patients — we used dressings containing lyophilized collagen solution (Zelenaya Dubrava, ZAO, RF), in II (comparison group) — 49 patients — traditional local treatment. Planimetric indices of the wound surface were measured using the MultiSpec program, and the assessment of treatment efficacy was determined as the ratio of the final area and depth of the wound to the initial values in percent. Results and their discussion. On admission, the wound area in the main group was 4.3 ± 3.7 cm2, whereas in the comparison group it was 4.1 ± 3.6 cm2. The final wound area (by 4-week measurement) decreased to 1.2 ± 1.3 cm2 in group I, whereas it was 2.6 ± 3.5 cm2 in group II. On 8–10 days after removal of purulent-necrotic tissues in the first group clinically there was a significant reduction of finger edema, cytologically there was no microflora in the wound discharge, phagocytosis was completed, whereas in the second group there was an inflammatory reaction (single areas of lysed leukocytes alternated with accumulation of leukocytes up to ¼ in f/v).Conclusions. Cytologically the effectiveness of collagen dressings application in complex treatment of diabetic foot ulcers was proved: by the end of the second week absence of inflammatory reaction and presence of proliferation signs in the majority of 69,4 % of patients. Planimetrically positive dynamics of the wound process was established: reduction of the area by the end of the 4th week in comparison with the initial one by 45,1 ± 33,8 % at traditional methods of treatment and by 79,9 ± 16,4 % at local use of collagen dressings, and depth — 53,1 ± 37,5 % and 76,8 ± 18,6 % respectively.

Comparison of the therapeutic efficacy of magneto-LED therapy and magnetostimulation applied as the adjuvant treatment of venous leg ulcers – preliminary study

ABSTRACT Purpose Venous leg ulcers are chronic wounds that are difficult to cure. The aim of the study was to compare the therapeutic efficacy of two methods of physical medicine – magneto-LED therapy and magnetostimulation, applied as adjuvant treatment in the treatment of venous leg ulcers. Methods The study included 81 patients, 37 male (45.6%) and 44 female (54.3%) ones, age range between 45 and 90 years, with venous leg ulcers. The patients were assigned to two study groups: magneto-LED therapy (group 1) or magnetostimulation (group 2). In both groups, a total of 40 daily procedures were performed. Wound healing was evaluated using computerized planimetry and the pain intensity on numeric rating scale. Results After treatment, the decrease in healing rate in group 1 was statistically significantly higher in comparison to group 2 (p < 0.001), while a statistically significant reduction in the surface area of ulcers was obtained, amounting on the average from 6.34 ± 1.29 cm2 to 2.31 ± 1.25 cm2 in group 1 (p < 0.001), and from 6.52 ± 1.20 cm2 to 4.79 ± 1.17 cm2 in group 2 (p < 0.001). The percentage changes of ulcers area in group 1 (64.21 ± 17.94%) were statistically significantly greater as compared to group 2 (25.87 ± 14.07%) (p < 0.001). After treatment, the decrease in pain relief in group 1 was statistically significantly higher in comparison to group 2 (p = 0.006), while pain intensity after treatment decreased statistically significantly in both compared groups of patients (p < 0.001). Conclusions Magneto-LED therapy and magnetostimulation caused significant reduction of surface area of the treated venous leg ulcers and pain intensity, yet magneto-LED therapy was more efficient. Both evaluated methods also significantly reduced pain intensity.

Bovine Pericardium Treated with Polyethylene Glycol and Ethanol Versus Pericranium for Duraplasty: A Pilot Study in Supratentorial Neurosurgery

Watertight closure of dura mater after intracranial surgery can avoid cerebrospinal fluid leakage and central nervous system infection and herniation. When primary closure is not possible, the pericranium is the preferential choice. When it is not available, a dural substitute becomes necessary. Bovine pericardium treated with polyethylene glycol and ethanol is herein tested as a dural substitute. A pilot study comparing bovine pericardium with pericranium in supratentorial neurosurgery was performed. Twenty patients were initially allocated into a bovine pericardium group (group 1) or a pericranium group (group 2). Three patients from group 1 and 2 from group 2 had a loss of follow-up, being excluded. In the remaining 15 patients, epidemiological analysis demonstrated a male:female ratio of 3:4 and 4:4 for groups 1 and 2. Ages varied from 28 to 68 (Mean= 49.6) in group 1 and 40-80 (Mean= 61.2) in group 2, with a mean difference of 11.68years (P= 0.09). Two cases of surgical site infection and 1 of hydrocephalus were observed. Although the calculated relative risk for complications was higher in group 1 (Relative Risk= 1.08), Fisher exact test demonstrated no statistically significant difference between groups (P= 1.00). Procedure mean time was 23minutes and 11seconds in group 1 versus 27minutes and 55seconds in group 2 (P= 0.47). Mean graft area was 13.17 and 6.23cm2 in groups 1 and 2 (P= 0.02). Bovine pericardium treated with polyethylene glycol and ethanol was comparable to pericranium as a dural substitute. More studies are encouraged to certify our findings.

A New Nomogram to Predict the Success of Shock Wave Lithotripsy in Ureteral Stones

Purpose. To design a new nomogram predicting the probability of stone‐free status of shock wave lithotripsy (SWL) in patients with ureteral stones. Materials and Methods. We retrospectively enrolled 2,144 patients with ureteral stones who underwent SWL between January 1993 and April 2020. The demographic and clinical parameters were assessed. The predictors of stone‐free status following SWL were identified. A logistic regression‐based nomogram was created by including the significant predictors in the multivariate analysis. Results. The mean age was 42.93 ± 13.85 in the stone‐free group (Group 1) and 46.51 ± 13.66 in the treatment‐failure group (Group 2) (p = 0.001). The cutoff value of the age was 45.5 years. The mean stone load was 0.71 ± 0.36 cm2 in Group 1 and 0.96 ± 0.51 cm2 in Group 2 (p = 0.001). Of the 2,144 patients, 1,708 (79.6%) were stone‐free within the first three SWL sessions. According to the multiple logistic regression analysis, older age, a stone load larger than 1 cm2, the presence of multiple stones, third‐generation lithotripter use, and pre‐SWL catheterization were statistically associated with low stone‐free rates. The C‐index was determined to be 0.75 in the bootstrapping method. Conclusion. A stone load larger than 1 cm2, age older than 45.5 years, the presence of multiple stones, new‐ (third‐) generation lithotripter use, and pre‐SWL catheterization had statistically significant effects on lower stone‐free rates in patients who underwent SWL due to ureteral stones. A nomogram was developed to predict the success of SWL. As a result of the internal validation of the nomogram, it was concluded to be suitable for clinical use.

Surgical outcomes of suprafascial and subfascial radial forearm free flaps in head and neck reconstruction.

Conventional radial forearm free flaps (RFFFs) are known to be safe, but can result in donor site complications. Based on our experiences with suprafascial and subfascial RFFFs, we evaluated the safety of flap survival and surgical outcomes. This was a retrospective study of head and neck reconstructions using RFFFs from 2006 to 2021. Thirty-two patients underwent procedures using either subfascial (group A) or suprafascial (group B) dissection for flap elevation. Data were collected on patient characteristics, flap size, and donor and recipient complications, and the two groups were compared. Thirteen of the 32 patients were in group A and 19 were in group B. Group A included 10 men and three women, with a mean age of 56.15 years, and group B included 16 men and three women, with a mean age of 59.11 years. The mean defect areas were 42.83 cm² and 33.32 cm², and the mean flap sizes were 50.96 cm² and 44.54 cm² in groups A and B, respectively. There were 13 donor site complications: eight (61.5%) in group A and five (26.3%) in group B. Flexor tendon exposure occurred in three patients in group A and in none in group B. All flaps survived completely. A recipient site complication occurred in two patients (15.4%) in group A and three patients (15.8%) in group B. Complications and flap survival were similar between the two groups. However, tendon exposure at the donor site was less prevalent in the suprafascial group, and the treatment period was shorter. Based on our data, suprafascial RFFF is a reliable and safe procedure for reconstruction of the head and neck.

The effect of Ranolazine on random pattern skin flap survival in rats

Objective: Flap surgery is widely used in the field of plastic surgery for defect reconstruction. The most important problem of this surgery is ischemic necrosis which may occur in the distal of the flap. For this reason, studies have been conducted to develop many treatment methods to solve this problem. Our study aimed to investigate the effects of different doses of ranolazine, a selective late sodium current blocker, on the viability of skin flaps prepared from the back of the rat. Material and Methods: A total of 32 rats, including 8 rats in each group, were included in the study. A random patterned caudal base 3x9 cm width : length modified McFarlane skin flap was elevated from the backs of all rats and adapted back to its place For 7 days postoperatively, 1 cc of saline was added to the control group (Group A), and 45 mg/kg, 90 mg/kg, and 180 mg/kg of ranolazine were added to the study groups (Group B, C, D), respectively, and administered daily with gastric lavage On the 7th postoperative day, photographs were taken to evaluate the viability of the flaps and scintigraphic evaluations were made. After the rats were sacrificed, the flaps were separated from their bases and evaluated histopathologically. Results: As a result of the evaluations, the viable flap area was calculated as 12.7548 cm2 for Group A, 14.9533 cm2, 16.494 cm2 and 16.7599 cm2 for Groups B, C and D, respectively, and a statistically significant difference was found between the groups (P = 0.00 &lt;0.05 ). The viable flap area percentages were calculated as 57.486% for Group A, 68.908% for Group B, 70.174% for Group C and 74.603% for Group D, and a statistically significant difference was found between the groups (P = 0.00 &lt;0.05). As a result of scintigraphic evaluation, the viable flap area was found to be 61.57% for Group A, 71.04% for Group B, 70.21% for Group C and 73.85% for Group D, and a statistically significant difference was found between the groups (P = 0.03 &lt;0.05). Histopathological evaluation revealed a decrease in the flaps' inflammation, edema and necrosis scores with the increasing drug dose. Conclusion: As a result, although flap viability increased with increasing doses in the group given ranolazine, more detailed studies are needed before it can be used clinically.

Arthroscopic Treatment of Femoral Condyle Chondral Lesions: Microfracture Versus Liquid Bioscaffold.

This study aims to compare the microfracture (MF) technique with the bioscaffold solution application (BST-CarGel) in treating femoral chondral lesions. Thirty-eight patients ages 18-45 with isolated single femoral condyle full-thickness (ICRS grade 3-4) chondral lesions were included in the study. Patients were divided into two groups as MF applied (Group I = 21) and bioscaffold combined with MF (Group II = 17). The visual analog scale (VAS), Western-Ontario, and McMaster Osteoarthritis Index (WOMAC) were used in clinical evaluation. The location, size, and depth of lesions were evaluated with preoperative magnetic resonance imaging (MRI). Magnetic resonance observation of cartilage repair tissue (MOCART) score was used for postoperative evaluation. The mean age was 32.5 (range 19-44) years. Mean follow-up was 14.9months (range 12-24). Lesion size was 3cm2 in group I and 2.9cm2 in group II. There were no differences between groups regarding demographic characteristics but BMI (Body Mass Index) was lower in group II which was significant. The duration of surgery was longer in group II (p < 0.001). Postoperative statistical significant improvements were found in WOMAC and VAS scores in groups, but there was no statistical difference. Although there was no significant radiological difference in the group II according to the MOCART score, higher scores were obtained compared to group I. No difference was found, clinical and radiological, in terms of short-term outcomes. MF is a method to be applied as a primary treatment with its cost-effective, simple and short surgery technique, and effective clinical results up to 4cm2. Level III: retrospective comparative study.

C-Arm a Useful Tool for Surgeons in Reduction of Zygomatic Complex Fracture: A Comparative Study: Article Type-Original Research.

Reduction of zygomaticomaxillary (ZMC) fracture is often difficult to evaluate intraoperatively because of it peculiar anatomy and limited accessibility. The purpose of this study is to evaluate the efficacy of use of C-arm as a tool for intraoperative monitoring of ZMC fracture reduction. Group I (C-Arm) and Group II (control group) comprised of patients with isolated unilateral displaced Zygomatic complex (ZMC) fractures and having orbital volume change. The efficacy of use of C-arm intra-operatively was evaluated to analyse the reduction of fracture. It was observed that mean change in ocular volume was around 1.07cm2 for Group I and 1.51cm2 in Group II. Thus post-operative eye volume was near to normal in Group I than Group II. The change in ocular volume post-operatively was observed to be statistically significant (p-value < 0.05) in both the groups. Post HOC Tukey statistical analysis determined the intergroup relation in change in eye volume between normal, pre- and post-operative and was found to be statistically significant (p-value < 0.05). The intergroup comparison between Group I and Group II was done using ANOVA statistical analysis and was found to be statistically significant (p-value < 0.05). Our study revealed that C-arm is definitively an effective tool in the oral and maxillofacial surgery armamentarium, giving better results with minimal surgical exposure and by eliminating operator related error. The online version contains supplementary material available at 10.1007/s12070-022-03221-y.

A New Safe and Ergonomic Manipulation Tool for the Flank-Free Supine Position: "U-Pad".

Introduction: One of the most important problems in the supine percutaneous approach to the kidney is the narrow surgical surface area (SSA) in the lumbar region. Herein, the spatial and angular geometric advantages of the U-shaped lumbar pad (U-Pad) used as a new positioning tool for safety and ergonomics in the supine percutaneous approach have been revealed. Materials and Methods: Data of patients who underwent endoscopic combined intrarenal surgery (ECIRS) using the U-Pad for kidney stones between March and September 2021 were prospectively collected. The demographic, preoperative, operative, and postoperative data of patients have been saved. The patients were positioned first with the standard gel pad (group 1) and then with the U-Pad (group 2). Both SSA (X and X+Y, cm2) and angular degree (α and β,°) calculations were compared. Fluoroscopy images with the same settings (97 kV/3.00 mA) were visually compared. In geometric data, trapezoidal area formula [(upper base + lower base) × height/2] and goniometer were used to compare with paired t-test. Results: ECIRS was performed on 17 patients, 13 men and 4 women, with a median age of 39 (range 32-47). The median body mass index was 26.2 (23.5-29.1). Stone localization and features were recorded. The median SSA was calculated as 35.7 cm2 in group 1 and 97.3 cm2 in group 2, and it was calculated that the total SSA increased to 272.5% with a median of 61.6 cm2 extra surgical area. Similarly, the downward manipulation angle was 32° (α°) in group 1, whereas it was 60.6° (β°) in group 2, and the median extra motion angle was calculated as 28.6° (89.3%). Conclusion: The U-Pad is a safe and rapid tool in the supine percutaneous approach to the kidney, providing at least two times the extra SSA and manipulation angle.

Single-Center Retrospective Comparative Study Evaluating the Benefit of Computed Tomography Angiography Prior to Prostatic Artery Embolization.

To explore whether a computed tomography angiography (CTA) of the pelvis prior to prostatic artery embolization (PAE) is a beneficial preprocedural planning tool regarding the technical success. Eighty patients with lower urinary tract symptoms treated with PAE were analyzed retrospectively. Forty of these patients received a CTA of the pelvis prior to the procedure (Group A) and were compared to 40 patients who were treated with PAE without prior CT imaging (Group B). Technical success rate, rate of complications, fluoroscopy time (FT), and mean dose area product (DAP) were assessed and compared. All operators performed at least 50 PAE prior to this study. When needed, cone-beam CT (CBCT) was available during intervention. Mean age was 68.43 ± 8.30years in Group A and 70.42 ± 7.11years in Group B (p = 0.252). Mean body mass index was 26.78 ± 3.73 in Group A and 26.85 ± 3.5 in Group B (p = 0.319). Overall technical success was 96.3%. Bilateral PAE was achieved in 60 patients (75.0%) while unilateral PAE was performed in 17 patients (21.3%). Technical failure (no embolization) occurred in two patients of Group A and one patient of Group B. No statistical significance was seen between groups for technical success rate (p = 1.0). Mean DAP was 10,164 × cm2 ± 3944cGy × cm2 in Group A and 10,039 × cm2 ± 3761cGy × cm2 in Group B (p = 0.885). Mean FT was 49.27 ± 22.97min in Group A and 44.32 ± 17.82min in Group B (p = 0.285). No intervention-related complications during PAE were reported. With experienced interventionalists and CBCT available during PAE, preprocedural CTA has no additional benefit for technical outcome.

Assessment of Utility of Lycopene, Selenium, and Vitamin E in Management of Oral Leukoplakia.

Objectives:To assess the utility of lycopene, selenium, and vitamin E in the management of leukoplakia.Materials and Methods:In this cross-sectional observational prospective study, 52 patients of oral leukoplakia were divided into 2 groups. Group I patients were prescribed 6 mg of lycopene, 400 I.U. of vitamin E, and 200 μg of selenium twice a day. Group II patients were prescribed a placebo capsule. The clinical improvement was recorded in both groups.Results:The mean pretreatment size of lesion in group I was 9.24 cm2 and in group II was 8.52 cm2. Post treatment size was 1.52 cm2 in group I and 6.28 cm2 in group II. There was a significant reduction in the size of lesion in group I compared to group II (P < 0.05).Conclusion:The treatment with a combination of lycopene, selenium, and vitamin E is useful and effective in managing the cases of oral leukoplakia.

Phototherapy (cluster multi-diode 630 nm and 940 nm) on the healing of pressure injury: A pilot study

The therapeutic benefits of LED in wound care have been reported since the 1990s. Nevertheless, studies directly related to the effects of LED phototherapy on the venous and arterial circulation and the healing process of pressure injuries are scarce in literature. Thus, the aim of this study was to evaluate the efficacy of a LED phototherapy prototype in participants with pressure injuries. In this pilot study 15 participants were randomized into three therapeutic groups. The experimental groups received applications of 630 and 940 nm LED three times a week for 8 weeks, with a dose of 6 J/cm2 in Group I. In group II, a dose of 8 J/cm2 in addition to the standard treatment. Group III (control group) received only daily standard treatment which consisted of cleaning the lesioned area with physiological solution, followed by application of an alginate hydrogel dressing over a period of 8 weeks. Pressure injuries were photographed and the area was measured by the Quantikov® image analyzer software. There was no statistically significant difference (p > 0.05) between the three groups when assessing the initial lesion area. At the end of 2 months, the median and interquartile ranges of the injuries were 5.90 (0.79–9.5) cm2 for group I, 0.54 (0.47–1.16) cm2 for group II and 26.76 (17.25–41.05) for group III. There was a statistically significant difference between treatment types (I x III and II x III) for pressure injuries over the 21 sessions. However, there was no significant difference between groups I x II that received different doses of LED phototherapy. The initial hypothesis was supported given that the combination of two wavelengths in the LED phototherapy with different doses may be helpful in accelerating the healing of pressure injuries.

Early repair of traumatic rotator cuff tears improves functional outcomes.

The impact of surgical timing on outcomes involving traumatic rotator cuff tears (RCTs) remains uncertain. The purpose of this study was to determine how functional outcomes are affected by surgical timing in traumatic RCTs. We performed a retrospective review of patients with repair of traumatic full-thickness RCTs. Preoperative magnetic resonance imaging scans were evaluated by 2 blinded reviewers to measure RCT area and muscular atrophy. Functional outcomes were assessed via the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Simple Shoulder Test score, and visual analog scale (VAS) pain score. Patients were divided into 4 groups based on the time from injury to surgery: 0-2 months (group 1), 2-4 months (group 2), 4-6 months (group 3), and 6-12 months (group 4). Multivariate analysis was performed to assess the impact of surgical timing on functional outcomes. A subanalysis was performed to assess outcomes in patients who underwent surgery within 3 weeks of injury. The study included 206 patients (150 men and 56 women) with a mean age of 60.0 ± 9.7 years and a minimum of 24 months' clinical follow-up (mean, 35.5 months; range, 24-54.4 months). The average tear area was 8.4 ± 6.3 cm2 in group 1 (66 patients), 5.8 ± 5.1 cm2 in group 2 (76 patients), 5.1 ± 4.6 cm2 in group 3 (29 patients), and 3.7 ± 3.1 cm2 in group 4 (35 patients) (P < .001). There were significant differences between the 4 cohorts in the final postoperative ASES score (P = .030) and VAS pain score (P = .032). The multivariate regression demonstrated that patients who underwent surgery within 4 months of injury had estimated improvements of 10.3 points in the ASES score (P = .008), 1.8 points in the Simple Shoulder Test score (P = .001), 8.6 points in the SANE score (P = .033), and 0.93 points in the VAS pain score (P = .028) compared with patients who underwent surgery later. The subanalysis demonstrated that patients who underwent surgery within 3 weeks of injury (n = 13) had significantly better VAS (P = .003), ASES (P = .008), and SANE (P = .019) scores than patients who underwent surgery at between 3 weeks and 4 months after injury (n = 129). This study demonstrates that surgical repair of traumatic RCTs results in significant improvements in functional outcomes for all patients; however, patients who undergo surgery within 3 weeks can expect the best functional outcomes, with a drop in function in patients who undergo surgery >4 months after injury.

Asymmetric Cross Sectional Area Size of the Psoas Muscle Seems to be a Key Feature in Patients with L4-5 Lumbar Disc Herniations.

To determine the relationship between the occurrence of lumbar L4-5 disc herniation (LDH) and the size of psoas muscles. The cross-sectional areas (CSAs) of the psoas muscles were measured at the L4-5 disc level on axial MRI of patients with LDH who were admitted to the hospital between 1 January 2020 and 1 June 2020. The patients were divided into three groups according to the involvement side of LDH as the patients without disc (Group I), right side disc (Group II), and left side disc (Group III). The relationship of ipsilateral and the opposite side of the CSA of PM in the control group and the patients with LDHs was analyzed. This retrospective study included 65 patients (ages between 20 and 70 years) whose mean age is 42, 12. The mean values of the right side cross-sectional area of PM were 12.09 cm2 in Group I (n=18), 12.84 cm2 in Group II (n=20), and 14.15 cm2 in Group III (n=27), The left side values were 12.08 cm2, 13.22 cm2, 14.00 cm2 in Group I, II, and III, respectively. The difference between right and left side CSA of PM is that values of patients with left-sided LDHs were higher than those of the control and right-sided LDH group, and the difference was statistically significant. A strong correlation was observed between the left and right side of the cross-sectional area of psoas muscle at the L4-5 level (p < 0.05). This study shows that there are reciprocal changes in the cross-sectional area of the psoas muscle in patients with L4-5 lumbar disc herniation.

Effect of three glass fiber post removal techniques on the amount of removed root dentin ''An in vitro study

Introduction: Glass fiber posts removal is a major obstacle in nonsurgical endodontic retreatment. The currently used removal techniques cause tooth structure loss in different amount. The aim of this study was to evaluate three glass fiber post removal techniques according to their effect on the amount of removed root dentin. Materials and Methods: Endodontic treatment was accomplished for 45 extracted single-rooted teeth. The teeth were decoronated and roots were cut apically at (11 mm) then fiber post spaces were prepared. Photographs of the apical cross-section for post space were taken using a camera at a magnification of 40. Fiber posts were cemented with dual cure resin cement. Then, the samples were divided into three groups (n = 15) depending on the fiber post removal technique: Group (I) DT post removal Kit, Group (II) ultrasonic tips E4D and Group (III) diamond bur and Peeso reamer. Posts were removed and images of the previous section were taken under the same magnification. AutoCAD program was used to compare the spaces difference between before and after removal images. Data were subjected to statistical analysis. Results: The average percentage of removed dentin was (1.89, 0.48, 0.09) cm2 in Groups I, II, and III, respectively. Group I showed the highest amount of removed dentin comparing to other groups, but no significant difference between Group II and Group III was recorded (P = 0.000). Conclusion: DT post removal kit group was the most aggressive technique for removing glass fiber.

A new classification for spinal epidural hematoma following microendoscopic decompressive laminotomy: A prospective clinical and magnetic resonance imaging study of 245 patients.

The aim of this study was to develop a new radiological classification system for postoperative spinal epidural hematoma (SEH) using magnetic resonance imaging (MRI) and to determine the correlation of this classification system with clinical and radiological outcomes. This prospective study included a total of 245 consecutive patients (126 females, 119 males; mean age=72 years; age range=39-91 years) with single level spinal stenosis who were treated by microendoscopic decompressive laminotomy (MEDL). MRI was performed for all patients 24 hours postoperatively and at 12 months. SHEs were categorized into four grades using our new MRI-based classification system based on the measurement of dural sac area: Grade A, small hematoma with a round shape; grade B, small hematoma that show no round shape; grade C, moderate hematoma; grade D: severe hematoma. Patients were then divided into four groups according to their hematoma grades, Group A, 107 patients with grade A hematomas; group B, 47 with grade B; group C, 67 with grade C; group D, 24 with grade D. Also, patients who had neurological deterioration or who pain resistant to medical treatment were treated surgically, and those were assigned to group H+(14 patients). The study, therefore, contained five groups. Clinical evaluation was done using Japanese Orthopaedic Association (JOA) score preoperatively and at 12 months postoperatively. No significant difference existed among groups in the preoperative median measurement of the dural sac area, which were 0.90 cm2 in group A, 0.80 cm2 in group B, 0.70 cm2 in group C, 1.1 cm2 in group D, and 0.80 cm2 in group H+ (p=0.076). At the postoperative 12-month measurement, no significant difference was noted among groups A (2.05 cm2), B (1.80 cm2 ), and H+ (1.90cm2) (A vs B: p=0.891, A vs H+: p=0.089, B vs H +: p=0.933). The measurements were greater in groups A and B than in groups C and D (p<0.05). Also, larger dural sac areas were determined in group H+ (1.90cm2) compared to Groups C (1.80 cm2) and D (1.60 cm2) but the difference reached no statistical significance (p=0.078). In preoperative JOA scores, there were no significant differences among groups (p>0.05). At 12-month JOA scores, no significant difference was observed between groups A and B (p=0.061) and between groups C and D (p=0.511). The scores were higher in groups A and B than in groups C and D (p<0.05). It seems that the narrower the preoperative dural sac area, the better the clinical symptoms of the patients with SEHs based on our new MRI-based classification system. This classification may be useful to predict the clinical status of these patients at one-year follow-up. Level IV, Diagnostic study.

Functional outcome of osteochondral autograft is equivalent in stable knee and in anterior cruciate ligament reconstruction

IntroductionAnterior cruciate ligament (ACL) tears are associated in 10% to 20% of cases with extensive traumatic focal osteochondral damage. Ligament reconstruction may require osteochondral autograft for symptomatic osteochondral lesions. Combined ACL and chondral or osteochondral reconstruction is poorly evaluated in the literature; osteochondral reconstruction in stable knee better documented. The objective of this study was to compare functional results after osteochondral autograft transfer (OAT) for significant symptomatic femoral condyle defect, in stable or stabilised knees (concomitant ACL reconstruction). The hypothesis was that functional results are equivalent in both groups. Material & methodThis was a single-centre retrospective comparative observational study of patients consecutively operated on between 2000 and 2018. Fifty patients met the inclusion criteria and were divided into two groups: Group 1 (OAT+ACL, n=13) and group 2 (OAT on stable knee, n=37). The following criteria were recorded at follow-up: pain (VAS), KOOS, IKDC and Lysholm scores and Hughston radiologic score, and time to return to sport. Mean follow-up was 79.7±60 months in group 1 and 86.4±62 months in group 2. ResultsTen patients were included for analysis in group 1 and 30 in group 2. Cartilage lesion size was comparable between groups: 1.6±1.20 cm2 for group 1 and 2.3±1.3 cm2 for group 2 (ns). One complication (infection with favourable course) was observed in group 2. Sport was resumed at 8.7±2.7 vs. 8.4±3.3 months, respectively. Mean subjective scores were respectively 83.3±7.4 and 75.4±14 for Lysholm, 89.7±7.8 and 89.7±19.6 for KOOS, 78±13.7 and 72.2±12.9 for subjective IKDC, 0.5±0.5 and 0.8±0.9 for pain on VAS and 3 and 3 for radiological Hughston radiologic score, with no significant differences between groups. ConclusionSymptomatic focal osteochondral lesions treated by osteochondral autograft transfer gives the same outcome on stable or stabilised knee. Level of evidenceIV; retrospective study.

Optimized protocol for repeated chest X-ray in a pediatric cardiac intensive care unit

BackgroundRadiographic examinations are crucial to diagnosis and management of young patients hospitalized in a pediatric Cardiac Intensive Care Unit (CICU). Since these infants are often subject to a large number of repeated X-ray examinations in order to follow up their clinical situation, special attention must be paid to use protocol aimed to dose reduction. ObjectiveThis work was aimed to perform a radiological survey of children undergoing chest X-ray examinations in a CICU. The study was focused on the evaluation of collimation, Dose-Area-Product (DAP) and Effective doses (E) to patients subjected to repeated examinations with optimized protocols. Materials and methodsAs suggested by the European Guidelines on Diagnostic Reference Levels (DRLs) for Pediatric Imaging, patients have been stratified in two groups (group I included newborn having weight < 5 kg while group II applied to infants with weight ranging from 5 to 15 kg). The study has involved 128 children undergoing chest X-ray examinations both with a standard (operator dependent) technique and with a proposed optimized protocol. ResultsThe integrated system DAP chamber has been validated. Data are related to examinations performed both with a standard technique (exposure parameters manually set by operators) and with an optimized protocol. The adoption of the optimized protocol resulted in a decrease of DAP and E for both weight groups. The median DAP values obtained with standard and optimized protocols respectively decrease from 4.0 to 3.4 mGy cm2 for group I and from 7.3 to 6.2 mGy cm2 for group II while effective doses decreased from 5.6 to 5.0 mGy cm2 for group I and from 5.0 to 4.2 mGy cm2 for group II. ConclusionThis work has shown that DAP and E values obtained with the optimized protocol were relatively low compared to previous literature. Particularly, DAP and E decrease up to 15% and 16% respectively using the optimized protocol. These results are particularly relevant for patients undergoing a great number of repeated X-ray examinations.

A COMPARATIVE STUDY OF TOPICAL INSULIN AND NORMAL SALINE DRESSING IN WOUND HEALING IN DIABETIC FOOT ULCER

Background: Diabetes mellitus is multifactorial multiorgan disease characterized by state of hyperglycemia in the body. The present study was conducted to compare topical insulin and normal saline dressing in wound healing in diabetic foot ulcer. Materials & Methods: The present study was conducted on 108 diabetic patients with diabetic foot ulcer of both genders. Patients were randomly classified into 2 groups. Each group comprised of 54 patients. Group I patients were treated with topical insulin dressings and group II patients were treated with normal saline dressings. Size of the ulcer was measured at the beginning and on regular interval after 7 days and 14 days. Mean depth and presence of slough was also recorded. Results: The mean size of the ulcer was 5.4 cm2 in group I and 5.2 cm2 in group II and depth of the ulcer was 8.2 mm in group I and 8.0 mm in group II. All 54 patients had slough in both groups and none had granulation tissue in both groups at day 0. The difference was non- significant (P> 0.05). The mean size of the ulcer was 3.8 cm2 in group I and 4.5 cm2 in group II and depth of the ulcer was 6.8 mm in group I and 7.8 mm in group II. 14 patients in group I and 28 in group II had slough and 40 patients in group I and 26 in group II had granulation tissue at day 7. The mean size of the ulcer was 1.8 cm2 in group I and 2.9 cm2 in group II and depth of the ulcer was 3.4 mm in group I and 4.8 mm in group II. 5 patients in group I and 20 patients in group II had had slough and 49 patients in group I and 34 in group II had granulation tissue at day 14. The difference was significant (P< 0.05). Conclusion: Authors found that topical insulin is efficient in patients with diabetic foot ulcer as compared to normal saline. There was fastest recovery and reduction in size of ulcer with insulin.