Efficacy Of Surgical Intervention Research Articles

A commentary on "efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study".

A commentary on "efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study".

Stereotactic Puncture Surgery for the Treatment of Moderate Volume of Thalamus-Internal Capsule Area Hemorrhage: An Analysis of Real-World Data

The efficacy of surgical intervention in ameliorating long-term prognosis for moderate volume of cerebral hemorrhage in the thalamus-internal capsule region remains unsubstantiated by clinical investigations. Consequently, the acquisition of credible evidence is imperative to authenticate the effectiveness of these methodologies. One hundred and three eligible patients with moderate-volume thalamus-internal capsule region cerebral hemorrhage. Twenty-seven pairs of successful matches after using the 1:1 propensity score matching (PSM) method, totaling 54 patients, were analyzed. The short- and long-term treatment outcomes of patients in the stereotactic surgery and conservative treatment groups were compared. The prognosis of the two groups of patients was analyzed by logistic regression analysis and model comparison. The primary outcome of this study was to assess Assessment of daily living(ADL) scores after 6 months of treatment.Based on the analysis of this study,the ADL of the surgical group were significantly higher than those of the conservative treatment group after 6 months of treatment (P< 0.001), and the difference was statistically significant. The amount of residual haematoma was significantly lower in the stereotactic surgery group than in the conservative treatment group at 3 days, 7 days and 2 weeks after the onset of the disease (P< 0.001), and the complication rate was lower than the conservative treatment group (P< 0.05). Univariate logistic regression showed that the risk of severe neurological dysfunction for patients in the surgery group was (OR-0.27, 95% CI: 0.08-0.86, P< 0.05). In multivariate logistic regression analysis, the odds ratio was 0.29 (95% CI: 0.09-0.96, P< 0.05) after adjusting for all covariates. For moderate-volume thalamus-internal capsule region cerebral hemorrhage, stereotactic paracentesis has the advantage of a shorter hospital stay and a lower complication rate than conservative treatment. Moreover, it yields superior outcomes in terms of daily living assessment scores after six months of treatment and enhanced neurological recovery.

Efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study.

Optimal treatment strategy for nonagenarians and centenarians with hip fractures (NCHF) remained unknown. The authors aimed to compare the outcomes of surgical and conservative management in NCHF. A prospective cohort study was conducted based on CPMHF database with NCHF patients hospitalized during 2014-2020. Comorbidities were evaluated by mECM score and restricted cubic spline was utilized to visually assess the dose-effect relationship between the mECM and outcomes. Propensity score matching was performed to balance baseline characteristics between nonsurgical and surgical groups. Multivariate logistic regression, Cox proportional hazard analysis, and survival analysis were employed for unfavorable outcomes (UFO) evaluation. Competing risk of death were analyzed based on Fine and Gray's hazard model and then constructed nomogram models for predicting survival rates. Subgroup analyses were used to determine potential population heterogeneity and sensitivity analyses were performed to test robustness of the results. The authors found increasing trends for UFO with the increase in the mECM score, and that high mECM score (HMS, ≥3) was independently associated with a 2.42-fold (95% CI: 2.07-3.54; P =0.024) increased risk of UFO, which remained significant after considering the competing role of death and were more pronounced in nonsurgical treatment, women, no insurance, and patients with spouse (all P for interaction <0.05). Surgical intervention was identified to be significant protective factors for UFO (RR, 0.59; 95% CI: 0.46-0.75; P <0.001) and severe complications (RR, 0.63; 95% CI: 0.41-0.96; P =0.033) after propensity score matching, as well as survival (HR, 0.40, 95% CI: 0.28-0.58; P <0.001), which remained significant after considering the competing role of death and in all sensitivity analyses and were more pronounced in HMS participants ( P for interaction=0.006). Subgroup analyses revealed surgical patients with HMS had a significantly higher UFO rate (excluding death, P <0.001) while nonsurgical patients with HMS had higher mortality rate as compared to the others ( P =0.005). Surgical treatment for NCHF yields better outcomes compared to conservative treatment.

Management of Craniosynostosis in Lethal Perinatal Hypophosphatasia.

Although perinatal lethal hypophosphatasia (HPP) was once a disease with a universally poor prognosis, it has now become a rare but treatable condition with the advent of enzyme replacement therapy with asfotase alfa. As a result, a greater population of patients with perinatal HPP are presenting with abnormal head shape and craniosynostosis. The authors present here 3 cases of perinatal lethal HPP, 1 treated with traditional open cranial vault remodeling and 2 treated utilizing distraction osteogenesis techniques. All patients demonstrated outcomes comparable to those previously reported with traditional observation or open cranial vault repair. Thorough consideration and discussion between the surgical team and patient's family is needed to determine a treatment plan that best addresses the goals of patient and family in light of recent advances in medical treatment in this rare patient population in which surgical interventions were previously nearly impossible. This article further supports the safety and efficacy of surgical intervention and explores the utility of distraction osteogenesis to address craniosynostosis in this patient population.

Лазерные технологии в лечении доброкачественной гиперплазии предстательной железы.

Introduction. Benign prostatic hyperplasia (BPH) is a common disease among men over 40 years old. Transurethral resection of the prostate has traditionally been considered the «gold standard» for surgical treatment of patients with BPH. The emergence and popularization of laser energy has led to the development of surgical technologies that can closely approach, and in some cases even exceed the effectiveness and safety of TURP. Materials and тethods. The data were searched in the PubMed, Web of Scince. databases of Google Scholar and the scientific electronic library eLibrary.RU using the following keywords: benign prostatic hyperplasia, surgical treatment; transurethral resection of the prostate; tulium laser; holmium laser; photoselective vaporization; GreenLight system; laser energy; cost-effectiveness. Among all currently available laser energies the greatest number of publications is devoted to the use of holmium and thulium energy for laser enucleation of the prostate (HoLEP and THuLEP). Results. The effectiveness of HoLEP has been well studied with papers on the use of this technique, including numerous randomized controlled trials. The safety and efficacy of surgical intervention in patients with a large prostate volume (&gt;100 g) was confirmed in 2000. The efficacy of the procedure was comparable to open surgery, while perioperative morbidity was lower in the group of patients who underwent HoLEP. The Tulium laser has a wavelength of 2013 nm and a penetration depth of 0.25 mm, using water as an absorbing chromophore. Unlike the holmium laser, energy is released in a continuous visible mode. This energy for the treatment of patients with BPH was first used in 2015. ThuLEP was studied in a metaanalysis by Kyriazis et al. Four studies (two randomized studies comparing ThuLEP with TURP or HoLEP and two prospective cohort studies with a follow-up period of 3-24 months) were included in this work. The authors reported an 87% reduction in prostate volume, a significant change in Qmax and IPSS, on par with TURP. Conclusion. A large variety of laser surgical systems are currently available, differing in the types of laser energy used. Surgical treatment of BPH can be performed using any method of laser surgery. The most promising and safe method for BPH treatment is the use of tulium laser energy. However, there is insufficient data on the cost-effectiveness of laser technologies.

Abordagem cirúrgica para cisto periapical de tamanho atípico em idosa: Relato de caso

Os cistos periapicais, são formados pelo processo inflamatório do epitélio no ápice de dentes não vitais. Normalmente apresenta características de crescimento lento, assintomático e de pequena extensão. Nesse estudo, objetiva-se reportar um caso de cisto periapical com tamanho atípico, submetido à abordagem cirúrgica. Aqui, trata-se de um estudo qualitativo, descritivo, retrospectivo e realizado pela da técnica da observação direta, respeitando todos os protocolos éticos. Paciente 74 anos, feminina, compareceu ao serviço de Cirurgia e Traumatologia Buco-maxilo-facial do Hospital da Restauração Governador Paulo Guerra - Recife, encaminhada por um cirurgião-dentista após análise de exame de imagem de rotina sugestivo de lesão cística em mandíbula. Ao exame físico apresentou discreto abaulamento em cortical vestibular de corpo mandibular direito, assintomático ao toque. Através da tomografia computadorizada se constatou uma área hipodensa, unilocular, circunscrita por uma linha hiperdensa, abrangendo região de dentes 42,43,44,e 45. Com base no exame clínico, foi estabelecida a hipótese diagnóstica de cisto periapical, confirmada após análise histopatológica. Como abordagem terapêutica optou-se por realizar sob anestesia geral a enucleação, osteotomia periférica e exodontias dos dentes envolvidos. Em 08 meses de acompanhamento não apresenta sinal de recidivas. Desse modo, fica claro a importância do correto diagnóstico, bem como a eficácia da intervenção cirúrgica como tratamento de lesão periapical de grande extensão.

Surgical intervention in patients with urothelial carcinoma of the bladder and lymph node metastasis.

To systematically review the most recent evidence on the role of surgery in patients with urothelial carcinoma of bladder and lymph node metastasis. Patients with urothelial carcinoma of bladder and lymph node metastasis have a poor prognosis. The mainstay treatment for these patients is systemic chemotherapy. However, slowly growing body of literature suggests that multimodal therapy comprised of radical cystectomy, lymph node dissection, and perioperative chemotherapy is more effective than either chemotherapy or surgery alone. The timing of chemotherapy, whether preoperative or adjuvant chemotherapy, is still controversial, but the current evidence indicates that patients who achieve a major or complete response after induction chemotherapy appear to benefit from the surgical intervention in the form of radical cystectomy and pelvic lymph node dissection. The limit of lymph node dissection has to be determined. Multimodal therapy is associated with better survival outcomes in bladder cancer patients with lymph node metastasis. The current guidelines recommend systemic chemotherapy as the mainstay of treatment for these patients, and there is no convincing evidence on the efficacy of surgical intervention in isolation. Nonetheless, studies comparing multiple treatment modalities demonstrated that surgical salvage therapy is beneficial only when combined with chemotherapy. The methodological limitations of the current literature preclude a robust conclusion of survival advantage. Further studies are needed to help improve imaging for detecting lymph node metastasis and novel strategies to enrich our multimodal therapeutic implementation.

A systematic review of the efficacy of surgical intervention in the management of symptomatic Tarlov cysts: a meta-analysis

Introduction: Tarlov cysts (TC) are sacral perineural cysts that are often found incidentally during spinal imaging. In a small fraction, symptomatic TC can cause pain, bowel, bladder and/or sexual dysfunction, as well as motor and sensory deficits. While many surgeons regard TCs as a non-operative entity, there have been suggestions that operative intervention in carefully selected symptomatic patients may be beneficial. The aim of this meta-analysis is to identify whether surgical treatment for symptomatic TCs is beneficial with an acceptable complication profile. Materials and methods: The authors conducted a systematic outcome analysis of symptomatic TCs treated either with surgery or conservatively managed. Results: Sixteen studies (N = 238) met the inclusion criteria for final meta-analysis. The literature search was performed using PubMed, Ovid MEDLINE, CINAHL, and EMBASE databases up to September 2017 and with an updated search in April 2019. The post-operative complication rate in patients undergoing surgical intervention was 16.9 (11.8 to 22.7) and cyst recurrence was 8.5 (3.5 to 15.4). When a complication occurred, the most frequent complication of surgical intervention was the development of a surgical site infection and/or CSF leak. Of the 15 studies reporting long-term follow-up, 81.0 (74.0–88.0) of patients remained symptom-free for more than 1 year (Mean: 27.5 months, SD = 11.5). Conclusion: We rigorously analyse the efficacy of open surgical decompression and repair of symptomatic TCs and corroborate the findings of sustained long-term resolution of symptoms.

Outcomes of olfaction in patients with empty nose syndrome after submucosal implantation

BackgroundOlfactory dysfunction, such as hyposmia, is a significant symptom of empty nose syndrome (ENS). The efficacy of surgical intervention in olfaction improvements for ENS has not been investigated extensively. ObjectiveThe aim of this study was to evaluate changes in olfaction after surgical treatment for ENS. MethodsThis prospective cohort study at a tertiary medical center enrolled patients with ENS indicated for surgical treatment between June 2015 and June 2019. The Sniffin’ Sticks 12-items odor identification test (SS-12) and subjective olfaction rating were completed by patients before and after surgery to assess olfaction. ResultsA total of 40 patients completed the survey both before and after surgical treatment. Prior to surgery, 25% of the patients had olfactory dysfunction detected by SS-12, whereas 80% of the patients reported a reduction in olfactory function by subjective rating. The degree of olfactory dysfunction by both assessments significantly improved following surgery. The age was a significant predictor of postoperative improvement. ConclusionSurgical treatment is helpful in improving olfaction in patients with ENS who commonly suffer from olfactory dysfunction. Younger patients may benefit more from surgical intervention in aspect of olfaction.

Hypotheses, rationale, design, and methods for prognostic evaluation of a randomized comparison between patients with coronary artery disease associated with ischemic cardiomyopathy who undergo medical or surgical treatment: MASS-VI (HF)

BackgroundIschemic cardiomyopathy and severe left ventricular dysfunction are well established to represent the main determinants of poor survival and premature death compared with preserved ventricular function. However, the role of myocardial revascularization as a therapeutic alternative is not known to improve the long-term prognosis in this group of patients. This study will investigate whether myocardial revascularization contributes to a better prognosis for patients compared with those treated with drugs alone and followed over the long term.MethodsThe study will include 600 patients with coronary artery disease associated with ischemic cardiomyopathy. The surgical or drug therapy option will be randomized, and the events considered for analysis will be all-cause mortality, nonfatal infarction, unstable angina requiring additional revascularization, and stroke. The events will be analyzed according to the intent-to-treat principle. Patients with multivessel coronary disease and left ventricular ejection fraction measurements of less than 35% will be included. In addition, myocardial ischemia will be documented by myocardial scintigraphy. Markers of myocardial necrosis will be checked at admission and after the procedure.DiscussionThe role of myocardial revascularization (CABG) in the treatment of patients with coronary artery disease and heart failure is not clearly established. The surgical option of revascularizing the myocardium is a procedure designed to reduce the load of myocardial hibernation in patients with heart failure caused by coronary artery disease. On the other hand, the assessment of myocardial viability is frequently used to identify patients with left ventricular ischemic dysfunction in which CABG may add survival benefit. However, the effectiveness of this option is uncertain. The great difficulty in establishing the efficacy of surgical intervention is based on the understanding of viability without ischemia. Thus, this study will include only patients with viable and truly ischemic myocardium to correct this anomaly.Trial registrationEvaluation of a randomized comparison between patients with coronary artery disease associated with ischemic cardiomyopathy submitted to medical or surgical treatment: MASS-VI (HF), ISRCTN77449548, Oct 10th, 2019 (retrospectively registered).

16. Discrepancies in the surgical management of central cord syndrome: assessment of nonoperative, surgical, and crossover to surgery patients

BACKGROUND CONTEXT The efficacy of surgical intervention for central cord syndrome (CCS) is shown in the literature; however, it is unclear whether disparities in patient presentation and treatment exist between those who initially undergo operative treatment and those who delay operative treatment. PURPOSE In a population of CCS patients, assess disparities in presentation and treatment between those undergoing immediate surgery and those who delay operative treatment. STUDY DESIGN/SETTING Retrospective analysis of New York State Inpatient Database years 2004-2013. PATIENT SAMPLE A total of 1,301 CCS patients (ICD-9 codes 952.03, 952.08, 952.13, 952.18). OUTCOME MEASURES Time to surgery, length of stay (LOS). METHODS Patient-specific linkage codes allowed longitudinal tracking of inpatient stays within the study period. Demographics, comorbidities (Charlson Comorbidity Index [CCI]), complications, and surgical factors, including Mirza invasiveness score, were compared between CCS patients that initially underwent surgery (Initial) and patients that delayed operative treatment (Delayed) using Chi-squared tests and independent samples t-tests as appropriate. Similar tests assessed differences in demographics and comorbidity burden between nonoperative patients and surgical crossover patients. RESULTS Included: 1,301 CCS patients (62±16 yrs, 27% female). Follow-up rate was 67.3%; mean follow-up time was 515±707 days. By level of CCS injury, 61.0% of patients were injured between C1 and C4, 59.2% between C5-C7, 1.0% between T1-T6, and 0.6% between T7-T12. Overall, 800 (61%) patients underwent surgical treatment (procedural breakdown: 80% fusion, 59% decompression, including 38% discectomy and 23% other decompression of the spinal canal). Of the surgical patients, 621 (78%) had surgery at first recorded hospital visit, while 179 (22%) experienced a delay before surgical treatment. For patients that delayed treatment, mean time to surgery was 203±358 days. Initial and Delayed patients did not differ in sex (p=0.109) or CCI (p=0.894), though Initial patients were younger than Delayed (60±15 yrs vs 63±13, p=0.016) and had lower rates of diabetes and valvular disease (both p 0.05). Patients who delayed operative treatment did not differ from nonop patients in age (63±13 vs 63±17, p=0.802) or CCI (1.04±1.49 vs 1.06±1.49, p=0.923); however, Delayed patients had higher rates of diabetes (26% vs 18%, p=0.037), neurologic disorders (7% vs 1%, p CONCLUSIONS Although patients managed with initial surgical treatment of CCS had longer hospital stays and were treated with more invasive procedures, perioperative complications did not differ. Twenty-two percent of CCS patients crossed over from nonoperative to operative treatment, with a mean time to crossover of 203 days. Patients who crossed over to operative care were more comorbid than patients who remained nonoperative, indicating comorbidity burden may play a role in the decision to operate. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Outcomes and swallowing evaluations after injection laryngoplasty for type I laryngeal cleft: Does age matter?

ObjectivesTo improve the recognition of differences in presentation amongst patients with type 1 laryngeal clefts of various ages and better understand the age dependent outcomes of injection laryngoplasty. A second aim was to analyze the discrepancies between swallow assessment modalities in various age groups with type I laryngeal clefts undergoing injection laryngoplasty. MethodsA retrospective review of electronic medical records of patients who underwent injection laryngoplasty from 2009 through 2015 at a tertiary care children's hospital. Data extracted included: Demographics, histories and physical exam findings, diagnostic studies, and medical and surgical treatments. ResultsMost (72/102, 70.6%) patients were male with a median gestational age at birth of 37 weeks (range 24–41 weeks). Formula thickening and GERD medications were used in 94/102 (92.2%) and 97/102 (95.1%) patients, respectively. Comorbid GERD, laryngomalacia, tracheomalacia, and subglottic stenosis were present in 98/102 (96.1%), 40/102 (39.2%), 9/102 (8.8%), and 14/102 (13.7%) patients, respectively. There was no significant difference in demographics, comorbidities or medical therapy between age groups. Symptoms at presentation differed between age groups with stridor (χ2(1) = 11.6, p = 0.002) and cyanosis (χ2(1) = 8.13, p = 0.012) being more common in the 0–3-month group compared to the 12–36 month group. Symptom resolution and the odds of undergoing additional surgery (second injection or suture repair) over time, however, did not differ. There was a significant reduction in aspiration with thins during FEES (McNemar χ2(1) = 10.7, p = 0.002) and aspiration with nectar during MBS (McNemar χ2(1) = 5.26, p = 0.035) post-injection. After injection, there was significant agreement in aspiration with thins between FEES and MBS (kappa = 0.308 ± SE 0.170, p = 0.035). However, finding aspiration with thins was more common during MBS than during FEES (McNemar χ2(1) = 7.00, p = 0.016). There were no differences in swallow evaluation findings between the age groups. ConclusionsSymptoms of type I laryngeal clefts may differ by age. However, there was no impact of age on the safety and efficacy of surgical intervention.

LAMELLAR MACULAR HOLE WITH LAMELLAR HOLE–ASSOCIATED EPIRETINAL PROLIFERATION IN FAMILIAL EXUDATIVE VITREORETINOPATHY

To present a clinical case of lamellar macular hole with lamellar hole-associated epiretinal proliferation in a pediatric familial exudative vitreoretinopathy patient. Retinal findings are described, and spectral domain optical coherence tomography documentation is provided. The efficacy of surgical intervention is also discussed. A 4-year-old girl presented with poor vision in her right eye, which was discovered during routine physical examination. Clinical examination revealed familial exudative vitreoretinopathy in both eyes and a lamellar macular hole in the right eye. Both of the patient's parents were also examined, which revealed familial exudative vitreoretinopathy in the girl's father. The patient underwent vitrectomy, inner limiting membrane and lamellar hole-associated epiretinal proliferation peeling, and air-fluid exchange. Images obtained with optical coherence tomography revealed lamellar hole-associated epiretinal proliferation at the lamellar defect edge in the patient's right eye. Postoperative examination showed that the lamellar macular hole had closed. Pediatric familial exudative vitreoretinopathy patients may develop lamellar macular hole with lamellar hole-associated epiretinal proliferation. Vitreoretinal surgery effectively closes this type of macular hole.

A retrospective study of perioperative outcomes following surgery for brain tumors: objective assessment and risk factor evaluation in rural centre

Abstract Background: Extensive surgical resection remains nowadays the best treatment available for most brain tumours. Perioperative outcomes following surgery for brain tumors are an important indicator of the safety as well as efficacy of surgical intervention. The goal of this study was to review the results of surgical treatment in our Department, run by a single neurosurgeon, in order to quantify morbidity and mortality and determine predictive risk factors for each patient. Materials and Methods: A total of Three hundred patients undergoing various surgeries for brain tumors were analyzed. Routine surgical techniques and uniform antibiotic policy were used. Navigation advanced operating microscope/ intraoperative electrophysiological monitoring was not available. The endpoints assessed included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Various risk factors assessed included clinicoepidemiological factors, tumor-related factors, and surgery-related factors. Results: Median age was 36.37 years. 74.3% had tumors larger than 4 cm. Neurological morbidity, and regional and systemic complications occurred in 14.3, 14.3, and 11.3%, respectively. Overall, major morbidity occurred in 14.3% and perioperative mortality rate was 3.3%. Conclusions: Our patients were younger and had larger tumors than were generally reported. Despite the unavailability of advanced intraoperative aids, we could achieve acceptable levels of morbidity and mortality rates. The knowledge of the complications rate in each particular neurosurgical department turns out essentially to provide the patient with tailored information about risks before surgery.

Surgical Resection for Epilepsy Following Cerebral Gunshot Wounds

The surgical management of epilepsy after penetrating gunshot wounds (GSWs) to the head has not been described in the modern era. Given the extensive damage to the cranium and cortex from such injuries, the safety and efficacy of surgical intervention are unclear. We report surgical strategy and outcomes after resection for medically refractory epilepsy following GSWs in 4 patients. A prospectively compiled database of 325 patients with epilepsy was used to identify patients undergoing surgery for medically refractory epilepsy after a GSW to the brain. Seizure frequency, scalp and intracranial electroencephalography evaluation, type of resection, and seizure outcomes were compiled. All 4 patients underwent direct electrocorticography recordings either with implanted electrodes or intraoperatively that were used to drive surgical decision making. All patients had intracranial shrapnel fragments and large areas of encephalomalacia on imaging. Intracranial electrodes were placed in 2 patients to localize seizure onsets. Two patients underwent frontal lobe resections, and the other 2 patients underwent multilobar resections. Latency between injury and epilepsy surgery was 12 years, and mean age at surgery was 28 years. In all cases, epilepsy surgery led to a significant improvement in seizure control (Engel class I, 2 patients; II, 1 patient; and III, 1 patient). Epilepsy is common after penetrating head injury, and the incidence is likely to increase given the growing numbers of armed conflicts in urban centers worldwide. In selected cases, intracranial monitoring and surgical resections may be safely performed and can lead to favorable seizure outcomes.

Noninvasive Measurement of Normal Foot and Ankle Joint Reaction Force

Category: Basic Sciences/Biologics Introduction/Purpose: Various biomechanical studies have examined pressure changes across the foot and ankle joints. However, most of these studies disrupted the capsuloligamentous complex surrounding the joint to insert pressure sensors, compromising the integrity of the natural joint structure and the accuracy of biomechanical assessments. This is the first noninvasive study to report measurement of natural joint reaction forces (JRF) across the foot and ankle while preserving all soft tissue structures. Since articular surfaces experience equal and opposing compression forces, we aimed to evaluate the distraction force needed to overcome these compression forces. Methods: Ten fresh-frozen cadavers of the lower extremity were obtained that were disarticulated at the knee joint. Steinmann pins were percutaneously placed across the distal tibia, and the center of the talus, navicular, cuboid, and calcaneus while preserving all surrounding soft tissues. A custom fixation device was utilized in conjunction with a tensile testing machine to allow distraction in line with the axis of the tibiotalar, subtalar, talonavicular (TN), and calcaneocuboid (CC) joints. Displacement was measured as distance between Steinmann pins on either side of the joint examined. Under progressive axial distraction, displacement and force were measured. Best-fit polynomials were calculated to fit the force-displacement curves. The inflection point, representing the joint reaction force (JRF) where distraction forces across the joint equal the compression forces, was calculated for each curve. Results: All force-displacement curves demonstrated an inflection point. Prior to the inflection point, relatively large increases in distraction force resulted in minimal displacement. Once the inflection point was reached, relatively small increases in distraction force resulted in large increases in displacement. Each cadaver was measured three times with high reproducibility. The mean JRF were tibiotalar 33.8 N [standard deviation (SD) 10], subtalar 18.2 N (SD 12), TN 13.3 N (SD 4), and CC 14.7 N (5.8). Conclusion: We present the first application of a reliable and noninvasive method of measuring JRF of the foot and ankle joints. In the medium or small joints, dissection of the capsule and surrounding ligaments can significantly alter joint stability and biomechanics. By preserving all the periarticular soft tissues, this experimental model will allow future investigation of biomechanical changes of pathologic states and efficacy of surgical intervention under conditions that most accurately reflect the in vivo state.

Efficacy of Surgical Intervention for the Treatment of Pain and Improvement of Quality of Life in Patients with Endometriosis

Introduction Endometriosis is a condition characterised by the presence of endometrial glands and stroma outside the uterus, which induces a chronic inflammatory reaction. It is estimated to affect 5%-15% of all women of childbearing age, with higher incidences in women suffering from pelvic pain (70%) and women with infertility issues (20%-48%). Objectives The purpose of this study is to examine the impact of surgical intervention on levels of pain and quality of life (QOL) experienced by patients undergoing surgical treatment for endometriosis in our unit. Methods This was a retrospective questionnaire-based study. Seventy-seven patients were identified in the hospital electronic database of surgeries. Patients were asked to rate levels of pain and QOL at the present time and to recall the same symptoms prior to undergoing surgery for endometriosis. The validated EQ-5D-3L assessment tool was used to measure QOL. Results Data from 26 patients were included in our final analysis. Significant reductions were demonstrated in pain scores before, during, after and between menstruations (p&lt;0.05), during intercourse (p&lt;0.01) and upon defecation (p&lt;0.05). There was a significant improvement in patients’ overall QOL following surgery (p&lt;0.01). Use of adhesion prevention intraoperatively or medication postoperatively did not result in significant differences in levels of pain or QOL. Conclusions Our results suggest that surgical intervention for endometriosis is an effective way to reduce pain and improve QOL in a majority of patients. However, this study design is susceptible to recall and selection bias, which may have impacted upon results.

Lung cancer surgery: an up to date.

According to the International Agency for Research on Cancer (IARC) GLOBOCAN World Cancer Report, lung cancer affects more than 1 million people a year worldwide. In Greece according to the 2008 GLOBOCAN report, there were 6,667 cases recorded, 18% of the total incidence of all cancers in the population. Furthermore, there were 6,402 deaths due to lung cancer, 23.5% of all deaths due to cancer. Therefore, in our country, lung cancer is the most common and deadly form of cancer for the male population. The most important prognostic indicator in lung cancer is the extent of disease. The Union Internationale Contre le Cancer (UICC) and the American Joint Committee for Cancer Staging (AJCC) developed the tumour, node, and metastases (TNM) staging system which attempts to define those patients who might be suitable for radical surgery or radical radiotherapy, from the majority, who will only be suitable for palliative measures. Surgery has an important part for the therapy of patients with lung cancer. "Lobectomy is the gold standard treatment". This statement may be challenged in cases of stage Ia cancer or in patients with limited pulmonary function. In these cases an anatomical segmentectomy with lymph node dissection is an acceptable alternative. Chest wall invasion is not a contraindication to resection. En-bloc rib resection and reconstruction is the treatment of choice. N2 disease represents both a spectrum of disease and the interface between surgical and non-surgical treatment of lung cancer Evidence from trials suggests that multizone or unresectable N2 disease should be treated primarily by chemoradiotherapy. There may be a role for surgery if N2 is downstaged to N0 and lobectomy is possible, but pneumonectomy is avoidable. Small cell lung cancer (SCLC) is considered a systemic disease at diagnosis, because the potential for hematogenous and lymphogenic metastases is very high. The efficacy of surgical intervention for SCLC is not clear. Lung cancer resection can be performed using several surgical techniques. Video-assisted thoracoscopic surgery (VATS) lobectomy is a safe, efficient, well accepted and widespread technique among thoracic surgeons. The 5-year survival rate following complete resection of lung cancer is stage dependent. Incomplete resection rarely is useful and cures the patient.

Fixed Subaortic Stenosis: A Clinical Dilemma for Clinicians and Patients

Subaortic stenosis carries considerable morbidity and mortality. In most cases, patients have an underlying left ventricular outflow tract morphology that promotes turbulence at the outflow tract, which induces the development of subaortic fibromuscular tissue. A subset of patients will progress to develop severe stenosis and aortic regurgitation, but it has been difficult to determine which patients are at risk. While resection of the subaortic tissue improves immediate outcome, many patients have recurrence of both stenosis and regurgitation, questioning the efficacy of surgical intervention in asymptomatic patients. This review article describes the current understanding of the etiology, treatment, and prognosis of subaortic stenosis.

Preliminary Results on Feasibility of Outpatient Instrumented Transforaminal Lumbar Interbody Fusion

A retrospective chart review study was performed. The primary objective of this study was to analyze our preliminary results to examine whether it is safe and effective to perform instrumented lumbar interbody fusions on an outpatient basis by comparing 2 groups of patients who were discharged the same day versus those who stayed overnight. The secondary objective was to identify the need for prolonged observation for complications that may occur in the immediate postoperative period. There is currently no information in the literature on the safety and complication rates of instrumented transforaminal lumbar interbody fusions performed in an ambulatory surgery setting. Surgeries were performed at an ambulatory surgery center (n=27) or hospital outpatient departments (n=25). The mean age of patients was 49.8 years (range, 19-72 y). The safety of outpatient lumbar fusions was assessed by analyzing complications that occurred from the moment of discharge up to the seventh postoperative day (0-7 POD), as well as all complications that occurred up to 6 months postoperatively (>7 POD). The efficacy of surgical intervention was also evaluated by assessing change in pain, patient satisfaction scores, and fusion rates. There were no cases of pneumonia, urinary tract infection, or thromboembolic complications. Four patients (14%) who had surgeries performed at an ambulatory surgery center had complications within 7 days postoperatively compared with 1 (4%) patient who had surgery performed at a hospital outpatient department. This difference was not statistically significant (P=0.36, Fisher exact test). Lower back and leg pain was significantly (P<0.0001) decreased postoperatively. The average postoperative back pain was 18.8 (range, 0-90) compared with 74.5 (range, 0-100) preoperatively as measured on a 0-100 visual analog scale. The average postoperative leg pain was 9.1 (range, 0-60) compared with 54.2 (range, 0-100) preoperatively. Although further confirmation is needed, this study discusses the possibility of performing instrumented lumbar interbody fusions with the transforaminal lumbar interbody fusion technique as an outpatient procedure. These results support a future prospective randomized study with a well-defined patient selection criteria.