Excellent Clinical Results Research Articles

HeartMate 3 Snoopy: Noninvasive cardiovascular diagnosis of patients with fully magnetically levitated blood pumps during echocardiographic speed ramp tests and Valsalva maneuvers

The HeartMate 3 (HM3) left ventricular assist device (LVAD) has demonstrated excellent clinical outcomes; however, pump speed optimization is challenging with the available HM3 monitoring. Therefore, this study reports on clinical HM3 parameters collected with a noninvasive HM3 monitoring system (HM3 Snoopy) during echocardiographic speed ramp tests and Valsalva maneuvers. In this prospective, single-center study, the HM3 data communication between the controller and pump was recorded with a novel data acquisition system. Twelve pump parameters sampled every second (1Hz) and clinical assessments (echocardiography, electrocardiogram (ECG), and blood pressure measurement) during speed ramp tests were analyzed using Pearson's correlation (r, median [IQR]). The cause for the occurrence of pulsatility index (PI)-events during ramp speed tests and valsalva maneuvers was investigated. In 24 patients (age: 58.9±8.8years, body mass index: 28.1±5.1kg/m2, female: 20.8%), 35 speed ramp tests were performed with speed changes in the range of ±1000rpm from a baseline speed of 5443±244rpm. Eight HM3 pump parameters from estimated flow, motor current, and LVAD speed together with blood pressure showed positive collinearities (r=0.9 [0.1]). Negative collinearities were observed for pump flow pulsatility, pulsatility index, rotor noise, and left ventricular diameters (r=-0.8 [0.1]), whereas rotor displacement and heartrate showed absence of collinearities (r=-0.1 [0.08]). In this study, the HM3 Snoopy was successfully used to acquire more parameters from the HM3 at a higher sampling rate. Analysis of HM3 per-second data provide additional clinical diagnostic information on heart-pump interactions and cause of PI-events.

Возможности неантибактериальной терапии и профилактики инфекций мочевыводящих путей.

Introduction. Recurrent urinary tract infections (RUTI) are one of the most common nosologies in the practice of a urologist. About half of all women will have at least one episode of urinary tract infection (UTI) during their lifetime. Antibiotic therapy remains the mainstay of treatment for UTI. The need to search for alternative options for the treatment and prevention of UTIs is dictated by the frequent use of antibacterial drugs. Most often they talk about the use of D-mannose and herbal remedies. The purpose of this literature review is to critically analyze clinical studies conducted to date that have examined the effectiveness and safety of D-mannose and herbal medicines for the prevention and treatment of RUTI. Materials and methods. 13 studies were analyzed that assessed the effectiveness of D-mannose and a combined herbal medicine with antibacterial therapy. Results. Herbal preparations from centaury herb, lovage roots, rosemary herb and lingonberry leaves in combination with D-mannose and antibacterial therapy had a number of advantages in clinical practice in the form of a decrease in the titer of pathogenic microflora. Conclusions. The NephroBest phytocomplex together with the polysaccharide D-mannose is well tolerated, has no side effects and demonstrates excellent clinical results in the form of reducing the risk of relapse, eliminating the pathogen, quickly reducing symptoms and improving laboratory parameters.

Complex Hypersensitivity and Irritation Reaction (CHAIR) Phenomenon after Cyanoacrylate Closure of Varicose Vein.

Cyanoacrylate glue is a non-thermal, non-tumescent agent used to treat saphenous reflux. It was introduced to overcome heat-related discomfort and complications. Multiple randomized controlled trials using this therapy have demonstrated excellent clinical outcomes at long-term follow-up. However, diffuse injection-site inflammation and systemic urticaria are worrisome complications. In preclinical studies, serial histopathological findings demonstrated acute inflammatory reaction, subacute vasculitis, chronic granulomatous foreign body reaction, fibrotic changes with partial vascular recanalization, and chronic foreign body-type inflammatory response. While the exact nature of this unique complication remains undefined, complex hypersensitivity and irritation reaction phenomena have been suggested based on reported clinical presentations. The incidence of this complication has been reported as ranging from 0.3%-25.4%. Typically, erythematous reactions can occur near treatment sites, with symptoms ranging from mild pruritus and/or erythema that resolves without treatment to recurrent severe inflammation and pruritus requiring nonsteroidal anti-inflammatory drugs, antihistamines, and/or corticosteroids. Surgical excision has been rarely reported in patients with severe intractable inflammation or treatment-site infections. Although several anecdotal studies reported on using antihistaminics or corticosteroids, no effective strategies have been established to prevent this complication.

Outcomes of large-diameter deep anterior lamellar keratoplasty and converted two-piece mushroom penetrating keratoplasty for herpetic corneal scars.

To report the clinical outcomes of large diameter deep anterior lamellar keratoplasty (DALK) and converted two-piece microkeratome-assisted mushroom keratoplasty (MK) for herpetic corneal scars. In this single-centre study, large diameter (9 mm) DALK was attempted in consecutive patients with herpetic corneal scars. In case of macroperforation or unsatisfactory clearance of the optical zone, the procedure was intraoperatively converted to two-piece microkeratome-assisted MK. Outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism, endothelial cell density (ECD), immunologic rejection, herpetic recurrence and graft failure rates in the two groups. DALK was successfully performed in 98 of 120 eyes, while the remaining 22 eyes required intraoperative conversion to MK. At 5 years, mean logMAR BSCVA was 0.10 ± 0.12 in the DALK group and 0.09 ± 0.15 in the MK group (P = 0.75). Refractive astigmatism at 5 years was 2.8 ± 1.4 D in the DALK group and 3.0 ± 1.7 D in the MK group (P = 0.67). ECD was higher in the DALK group than in the MK group at all time points (P < 0.001), with a mean annual cell loss of 10.9% after MK and 4.2% after DALK. The 5-year risk for immunologic rejection (DALK: 3%, MK: 5%, P = 0.38), herpetic recurrence (DALK: 6%, MK: 9%, P = 0.38), and graft failure (DALK: 4%, MK: 5%, P = 0.75) were comparable in both groups. Large diameter (9 mm) DALK yields excellent visual and clinical outcomes in eyes with herpetic corneal scars. In case of intraoperative complications, DALK can be converted to two-piece microkeratome-assisted MK to maximize the refractive benefit of a large diameter graft while minimizing the risk of endothelial failure.

ANTERIOR AESTHETIC REHABILITATION WITH GINGIVECTOMY AND COMPOSITE RESIN VENEERS

The advancement of surgical procedures for gingival repair and restorative treatments for anterior teeth, which stand out in the scientific community, has been fundamentally influenced by the pursuit of aesthetics. The purpose of the current study is to describe the clinical behaviour of a patient who has small teeth and a gummy smile. The goal was to use a clinical case to illustrate how anterior cosmetic rehabilitation, which includes gingivectomy and composite resin veneers, can be accomplished. The restoration of anterior teeth involves using better shades, colours, opacities, translucency, and anatomical onformation, while treatments that combine dentistry and periodontics are capable of producing good results, enabling normalisation of the gums, correcting their deformities, and restoring the interdental grooves and papillae. Periodontal surgery called a gingivectomy involves removing extra gum tissue. The purpose of the procedure is to change the tooth’s contour, which generates an increase in the clinical crown, providing a smile with adequate protection and support for the oral environment. Resin veneers or direct restoration on anterior teeth are the dental remodelling treatment that guarantees longevity and satisfactory results, in addition to being minimally invasive. The adhesive systems and composite resins available are of high quality, do not impose aesthetic limits, and allow a natural effect determined by the excellence and technical knowledge of the operator. The plan accomplishment allowed reaching the aesthetic principles and establishing a better contour shape and size, both of the gingival tissue and of the anterior teeth. Thus, the procedure was always performed prioritising the demands and satisfaction of the patient, generating excellent clinical results. This research is duly authorized by Opinion: 6.275.546 CEP/CONEP.

Coracoid Process Fracture Associated With a Distal Clavicle Fracture: A Case Report

Background. Fracture of the distal clavicle fracture associated with a coracoid process fracture is extremely rare in the practice of an orthopedic surgeon. Therefore, there is no common approach to the treatment of patients with this type of bone injuries of the shoulder girdle.&#x0D; Aim of the study to demonstrate positive experience of conservative treatment of the coracoid process fracture combined with hook plate fixation for distal clavicle fracture.&#x0D; Case presentation. We present a rare clinical case of a closed distal clavicle fracture associated with coracoid process fracture. Trauma occurred when the patient fell down the stairs on his abducted upper limb. After examination, the distal clavicle fracture was fixed with a hook plate. Intraoperatively, X-rays showed a satisfactory position of the coracoid process of the scapula. Therefore, it was decided not to fix it additionally. CT scans three months after the surgery showed bone fragments consolidation. Removal of the hook plate and screws from the clavicle was performed.&#x0D; Conclusion. Presented clinical case illustrates successful treatment result of this type of fractures without fixation of the coracoid process fracture. The hook plating allows to stabilize bone fragments and restore ligament tension, which makes this implant non-alternative for fixation of this type of injuries.

Superior mesenteric artery-related outcomes in fenestrated/branched endografting for complex aortic aneurysms.

Early/follow-up durability of superior mesenteric artery (SMA) stent-grafts is crucial after fenestrated/branched endografting (FB-EVAR) in complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs). The study aimed to report early/midterm outcomes of SMA incorporated during FB-EVAR procedures. FB-EVAR procedures performed between 2016 and 2021 in a single institution were reviewed. Anatomical SMA characteristics were analyzed. The SMA configuration was classified into three types according to the angle between the SMA main trunk and the aorta: (A) perpendicular, (B) downward, and (C) upward. SMA-related technical success (SMA-TS: cannulation and stenting, patency at completion angiography without endoleak, stenosis/kinking, dissection, bleeding, and 24-h mortality) and SMA-adverse events (SMA-AEs: one among bowel ischemia, stenosis, occlusion, endoleak, reinterventions, or SMA-related mortality) were assessed. Two hundred FB-EVAR procedures with SMA as the target artery were performed. The indication for FB-EVAR was CAAAs and TAAAs in 99 (49%) and 101 (51%) cases, respectively. The SMA configuration was A, B, and C in 132 (66%), 63 (31%), and 5 (3%) cases, respectively. SMA was incorporated with fenestrations and branches in 131 (66%) and 69 (34%) cases, respectively. Directional branch (P < .001), aortic diameter ≥35 mm at the SMA level (P < .001), and ≥2 SMA bridging stent-grafts (P = .001) were more frequent in TAAAs. Relining of the SMA stent-graft with a bare metal stent was necessary in 41 (21%) cases to correct an acute angle between the stent-graft and native artery (39), stent-graft stenosis (1), or SMA dissection (1). Relining was associated with type A or C SMA configuration (OR: 17; 95% CI: 1.8-157.3; P = .01). SMA-TS was achieved in all cases. Overall, 15 (7.5%) patients had SMA-AEs [early: 9 (60%), follow-up: 6 (40%)] due to stenosis (2), endoleak (8), and bowel ischemia (5). Aortic diameter ≥35 mm at the SMA level was an independent risk factor for SMA-AEs (OR: 4; 95% CI: 1.4-13.8; P = .01). Fourteen (7%) patients died during hospitalization with 10 (5%) events within the 30-postoperative day. Emergency cases (OR: 33; 95% CI: 5.7-191.3; P = .001), peripheral arterial occlusive disease (OR: 14; 95% CI: 2.3-88.8; P = .004), and bowel ischemia (OR: 41; 95% CI: 1.9-87.9; P = .01) were risk factors for 30-day/in-hospital mortality. The mean follow-up was 32 ± 24 months; estimated 3-year survival was 81%, with no case of late SMA-related mortality or occlusion. The estimated 3-year freedom from overall and SMA-related reinterventions was 74% and 95%, respectively. SMA orientation determines the necessity of stent-graft relining. Aortic diameter ≥35 mm at the SMA level is a predictor of SMA-AEs. Nevertheless, SMA-related outcomes of FB-EVAR are satisfactory, with excellent technical success and promising clinical outcomes during the follow-up.

A 3–4 h oocyte retrieval-ICSI interval optimizes clinical outcomes for women over 40 years

To explore an appropriate time interval between oocyte retrieval and intracytoplasmic sperm injection (ICSI) for optimal embryological and clinical outcomes in ICSI cycles over 40 years of maternal age. A retrospective analysis of 1476 ICSI fresh cycles from women aged over 40 years, was performed at the Reproduction Medicine Research Center of the Sixth Affiliated Hospital of Sun Yat-sen University, between December 2013 and August 2020. The fertilization rate and clinical pregnancy rate were the main outcomes. Multivariate linear regression and logistic regression analysis of factors showed that fertilization rate (P = 0.024) and clinical pregnancy rate (P = 0.011) were significantly associated with oocyte pick up (OPU)-ICSI interval. A longer OPU-ICSI interval (no more than 6 h) was associated with a higher fertilization rate but significantly decreased the clinical pregnancy rate when the OPU-ICSI interval was over 4 h (P < 0.05). The optimal OPU-ICSI interval is between 3 and 4 h for excellent embryological and clinical outcomes in ICSI cycles over 40 years of maternal age.

New Operative Protocol for Immediate Post-Extraction Implant in Lower-First-Molar Region with Rex-Blade Implants: A Case Series with 18 Months of Follow-Up

In this manuscript, the authors propose a new technique for inserting implants immediately into the sockets corresponding to the lower first molars and, in any case, in the sockets in which the alveolar septum is still present. Immediate post-extraction implants are a widely discussed topic in the literature. Most authors currently consider the insertion of implants immediately after extraction less useful in terms of the procedure’s questionable benefits in maintaining the height of the alveolar bone and more useful in terms of lessening patients’ discomfort. Due to the anatomy of the post-extraction socket and its traditionally cylindrical geometry, this procedure is not always possible.: Next-generation REX-type blade implants were used via their insertion into the septum accompanied by a cortical lamina for periosteal inhibition without filling any of the alveoli.: In the 20 patients treated, the REX implant proved to be stable and surrounded by newly formed bone at the 18-month follow-up. This simple, easily employable technique allows an implant to be inserted immediately after extraction and in the same surgical session, with good patient compliance and good preservation of the alveolus due to the facilitation of periosteal inhibition. The excellent clinical results obtained with the use of a blade implant in the posterior sectors suggest that it is possible to reduce surgical sessions even in conditions of post-extraction sockets whose septum alone can ensure the primary stability essential for osseointegration. The use of a larger number of patients will also provide us with significant statistical results in support of this preliminary clinical work. New clinical studies are needed to understand the true potential of this method for application in daily clinical practice.

Anatomic repair and ligament bracing as an alternative treatment option for acute combined PCL injuries involving the posteromedial or posterolateral corner—results of a multicentre study

IntroductionCombined PCL injuries involving the posteromedial/-lateral corner (PMC/PLC) usually require surgical management. Literature shows controversy regarding the standards of treatment. Suture-augmented repair leads to excellent results in acute knee dislocations but has not been investigated clinically in combined PCL injuries. The purpose of this multicentre study was to evaluate the clinical outcome of this technique in acute combined PCL injuries.Materials & methodsN = 33 patients with acute combined PCL injuries involving the PMC/PLC were treated by one-stage suture repair with ligament bracing of the PCL and suture repair of the accompanying PMC/PLC injuries with/without ligament bracing or primary augmentation by semitendinosus autograft. Outcome was assessed by IKDC questionnaire, Lysholm Score, Tegner Activity Scale and KOOS. Additional PCL stress-radiography was performed.ResultsN = 31 patients with combined PCL injuries (female: male = 7:24; age 39.1 ± 13.8 years) with a follow-up of 16.8 ± 9.6 months were finally evaluated. 18 had PMC injuries, 13 PLC injuries. 32.2% presented with accompanying meniscal tears (70% medial meniscus). 19.4% showed cartilage injuries grade III-IV. Complications included one infection and four knee stiffnesses. Three had symptomatic postoperative instability, all affiliated to the PLC group. The IKDC was 69.8 ± 16.5, Lysholm score 85 ± 14.4 and KOOS 89.7 ± 8.1. Median loss of activity (Tegner) was 0.89 ± 1.31. Comparing PMC and PLC, all scores showed a tendency towards more favourable outcomes in the PMC group (n.s.). Stress-radiography showed an overall side-to-side difference of 3.7 ± 3.8 mm. Subgroup evaluation showed statistically significant better results (p = 0.035) of PMC (2.5 ± 1.5 mm) versus PLC (5.8 ± 5.6 mm).ConclusionsOne-stage suture repair with ligament bracing is a viable technique for acute combined PCL injuries and predominantly leads to good and excellent clinical outcomes. Patients with PLC injuries show a tendency towards inferior outcomes and higher instability rates compared to PMC injuries. These results may help in therapy planning and counselling patients with these rare injury pattern.Level of evidenceLevel II.

Impaction bone grafting for contained acetabular defects in total hip arthroplasty

BackgroundAcetabular bone loss is a technical challenge in total hip arthroplasty (THA). This study sought to report the functional and radiological results of acetabular reconstruction using impaction bone grafting (IBG) in patients with acetabular bone deficiency undergoing primary or revision THA.MethodsIn this prospective study, full history taking, preoperative clinical and radiological evaluation, and preoperative planning and templating were performed. The Paprosky classification and the American Academy of Orthopaedic Surgeons classification were used to assess the acetabular deficiencies. Clinical outcomes were assessed utilizing the Harris hip score (HHS) and a 4-question satisfaction questionnaire. Graft incorporation was evaluated in the last follow-up X-rays.ResultsThis study included 50 patients with a mean age of 46.7 ± 15.3 years. The THA was primary in 14 (28%) patients and revision in 36 (72%) patients. The mean HHS improved significantly from 28.8 ± 24.1 preoperatively to 76.6 ± 6.1, with a mean follow-up period of 23 months. Overall, 88% of patients were very satisfied. Complete radiological graft incorporation to host bone was achieved in 35 (70%) patients, and the remaining patients had partial incorporation. Complete graft incorporation was associated more frequently with primary THA, autografts, cementless cups, decreased defect size, and decreased graft layer thickness.ConclusionsIBG for acetabular reconstruction in THA can achieve excellent clinical and radiological outcomes with a low complication rate.Level of evidenceLevel IV.

Efficacy, Safety, and Clinical Outcomes of Splenorenal Shunt Surgery as a Therapeutic Intervention for Portal Hypertension Patients

Highlights: 1. This study systematically reviewed the efficacy, clinical outcomes, and safety of the splenorenal shunt procedure with a comprehensive and meticulous approach.2. The splenorenal shunt procedure is an innovative surgical intervention that offers a viable option for the management of portal hypertension. Abstract Portal hypertension is the second most common gastrointestinal bleeding in cirrhosis and non-cirrhosis patients. The splenorenal shunt surgery is a potential intervention that may be considered for portal hypertension patients with clinical symptoms such as upper gastrointestinal bleeding caused by the rupture of gastro-esophageal varices. In this study, the researchers aimed to analyze the efficacy, clinical outcomes, and safety of splenorenal shunt surgery in portal hypertension patients. The sources were obtained from electronic search databases, including PubMed, Google Scholar, and ScienceDirect, using the keywords "Efficacy," "Safety," and "Clinical Outcomes." in relation to splenorenal shunt surgery in portal hypertension patients. The researchers set specific criteria for inclusion and exclusion to select the articles. This systematic review revealed the efficacy of the splenorenal shunt procedure with favorable outcomes. The success rate of splenorenal shunt surgery in reducing the clinical symptoms of portal hypertension varied between 66% and 100%. The prevailing complications observed in this study were shunt thrombosis, rebleeding, and thrombocytopenia. However, notable improvements could be achieved with general treatment. In terms of short- and long-term clinical outcomes, the splenorenal shunt procedure demonstrated favorable results. It can be concluded that splenorenal shunt surgery provides excellent clinical outcomes and should be considered a viable treatment option for patients with both cirrhotic and non-cirrhotic portal hypertension.

Management of Small Bowel Neuroendocrine Tumours: 10 Years' Experience at a Tertiary Referral Centre.

Neuroendocrine tumours (NET) arising from the small bowel are clinically challenging and are often diagnosed at advanced stages. Disease control with surgery alone can be demanding. Multimodal treatment concepts integrating surgery and non-surgical modalities could be of benefit. Retrospective review of consecutive adult patients with SB NET treated at Imperial College Healthcare NHS Trust between 1 January 2010 and 31 December 2019. Data regarding clinicopathological characteristics, treatments, and disease trajectory were extracted and summarised. Overall and progression/recurrence-free survival were estimated at 5 and 10 years. 154 patients were identified, with a median age of 64 years (range 33-87); 135/154 (87.7%) had stage III/IV disease at diagnosis. Surgery was used in 125 individuals (81.2%), typically with either segmental small bowel resection (60.8%) or right hemicolectomy (33.6%) and mesenteric lymphadenectomy for the primary tumour. Systemic and/or liver-directed therapies were used in 126 (81.8%); 60 (47.6%) had more than one line of non-surgical treatment. Median follow-up was 67.2 months (range 3.1-310.4); overall survival at 5 and 10 years was 91.0% (95% CI: 84.9-94.7%) and 82.5% (95% CI: 72.9-88.9%), respectively. Imaging-based median progression-free survival was 42.7 months (95% CI: 24.7 to 72.4); 5-year progression-free survival was 63.4% (95% CI: 55.0-70.6%); 10-year progression-free survival was 18.7% (95% CI: 12.4-26.1). Nineteen patients (12.3%) reached 10 years follow-up without disease recurrence and therefore were considered cured. Most patients with SB NET present in a metastasised stage. Multimodal treatment concepts may be associated with excellent clinical outcomes. Future work should explore optimal approaches to treatment sequencing and patient selection.

Minimally Invasive Gingival Recession Treatment by Using Vista Combined With PRF and Collagen Membrane: A Case Report

Abstract Root exposure generates major concerns regarding aesthetics and other problems like hypersensitivity and root caries. Gingival recession has traditionally been treated by periodontal plastic surgery, often using soft tissue grafts to fill the defect with excellent clinical results. Advancements in root coverage procedures in the aesthetic zone have led to increasing the ability of clinicians to harness a treatment modality that delivers better outcomes with less surgical morbidity. Collagen membrane is most commonly used for guided tissue regeneration (GTR). On the other hand, platelet-rich fibrin (PRF) has gained popularity due to its simple method of acquisition, low cost and the presence of growth factors. Therefore, this case report describes the treatment of a 38-year-old patient with bilateral multiple Miller’s class I recession defects extending from central incisors to canines by using the vestibular incision subperiosteal tunnel access (VISTA) with PRF and collagen membrane. Clinical parameters such as recession height (RH) and width of keratinised gingiva (WKG) were measured at 6-month and 1-year follow up intervals. The 6-month follow-up revealed optimum root coverage with excellent outcomes for both sites, with an increase in the width of keratinised gingiva and a decrease in the recession height, and less discomfort in the site treated with a PRF membrane. These clinical parameters were maintained at the 1-year follow up. The increase in the width of keratinised gingiva and the decrease in the recession height in both groups and the patient compliance due to this minimally invasive procedure suggests its potential use when aesthetics and patient comfort are of paramount concern.

Ultrasound-guided stenting in the common femoral vein for accurate stent distal landing.

Venous stenting has been reported with excellent clinical results; however, inadequate inflow can increase the risk of stent occlusion. When extending the stent into the common femoral vein (CFV), it is essential to ensure adequate inflow from the femoral vein, deep femoral vein (DFV), and great saphenous vein. Accurate identification of the distal landing zone (DLZ) of the stent is crucial to ensure adequate inflow. The DLZ is usually determined by venography or intravascular ultrasound (IVUS) with reference to bony landmarks. However, the uncertainty can lead to misidentification of the DLZ and inadequate stent placement, resulting in stent occlusion. From December 2016 to December 2022, 42 venous stent placements were performed in 40 patients with post-thrombotic iliofemoral vein obstruction and/or stenosis. Three patients had developed early stent occlusion owing to a misidentified DLZ. To improve accuracy in identifying the DLZ during venous stenting, ultrasound-guided placement was performed in the CFV of five patients (four on the left and one on the right) with post-thrombotic changes in the CFV and occlusion of the common iliac vein and external iliac vein. The distal end of the stent was adjusted just above the saphenofemoral junction in two cases and just proximal to the DFV confluence in three cases. Stent placement was verified using both long-axis ultrasound and fluoroscopy. Ultrasound images of the CFV region provided clear visualization of the stent deployment site and accurate landmark locations, such as the saphenofemoral junction and DFV confluence, allowing for precise adjustments during stent deployment. This technique enabled easier and more definitive identification of other branches of the CFV than previously provided by IVUS and venography. No complications were observed in any of the 42 cases, and long-term patency was achieved at the final follow-up after stenting (average, 10months; range, 3-14months). Ultrasound-guided stenting in the CFV allows for real-time and accurate stent deployment with precise adjustment to the optimal DLZ. Using this technique, combined with venography and IVUS, missed distal lesions and subsequent stent occlusion can be prevented, potentially contributing to better treatment outcomes.

Prosthetic resurfacing of engaging posterior capitellar defects in recurrent posterolateral rotatory instability of the elbow.

Posterolateral rotatory instability (PLRI) is a common mechanism of recurrent elbow instability. While the essential lesion is a deficiency in the lateral ulnar collateral ligament (LUCL), there are often associated concomitant bony lesions, such as an Osborne-Cotterill lesions (posterior capitellar fractures) and marginal radial head fractures, that compromise stability. Currently, there is no standard treatment for posterior capitellar deficiency associated with recurrent PLRI. We conducted a retrospective review of five patients with recurrent PLRI of the elbow associated with a posterior capitellar impaction fracture engaging with the radial head during normal range of motion. The patients were treated surgically with LUCL reconstruction or repair and off-label reconstruction of the capitellar joint surface using a small metal prosthesis designed for metatarsal head resurfacing (HemiCAP toe classic). Five patients (three adolescent males, two adult females) were treated between 2007 and 2018. At a median follow-up of 5 years, all patients had complete relief of their symptomatic instability. No patients had pain at rest, but two patients had mild pain (visual analog scale 1-3) during physical activity. Three patients rated their elbow as normal, one as almost normal, and one as greatly improved. On short-term radiographic follow-up there were no signs of implant loosening. None of the patients needed reoperation. Recurrent PLRI of the elbow associated with an engaging posterior capitellar lesion can be treated successfully by LUCL reconstruction and repair and filling of the capitellar defect with a metal prosthesis. This treatment option has excellent clinical results in the short-medium term. Level of evidence: IV.

Suture suspension sling arthroplasty in thumb carpometacarpal joint arthritis: A case series.

Thumb carpometacarpal (CMC) joint arthritis is the most common condition in older adults and an upper-extremity surgical reconstruction site. Multiple treatments for CMC arthritis have been developed. Among them, suspension sling arthroplasty provides great results without requiring a tendon graft or advanced implants. However, it is rarely used in Indonesia. The modified suture suspension sling arthroplasty technique developed by Arnold Peter C Weiss was performed on three patients with CMC joint arthritis. In this procedure, after trapeziectomy, a nonabsorbable suture is performed to create a hammock between the abductor pollicis longus and flexor carpi radialis tendon to rest the thumb base metacarpal. The rehabilitation protocol was then continued, and the postoperative clinical condition was observed. Three weeks postoperatively, none of the three patients complained of pain. At 3months postoperatively, there were no signs of infection, and all patients continued the rehabilitation protocol. At 6months postoperatively, thumb range of motion was excellent, with no sign of infection and an increased DASH score of <5. Multiple treatments for CMC joint arthritis have been described in the literature but the indications and which treatment provides the best results were unclear. Among the various suspension sling methods, trapeziectomy is important for treating CMC joint arthritis. Suture suspension arthroplasty for treating thumb CMC joint arthritis achieved excellent clinical results and has several advantages, including shorter surgical time, no additional incision, reduced cost, no tendon harvesting, and implant fixation.

Total hip replacement in a patient with contralateral hemipelvectomy: a case report

Total hip arthroplasty is one of the most frequently performed surgeries today with excellent clinical and functional results for patients with advanced stages of hip osteoarthritis. Performing this surgical procedure in patients with a history of lower limb amputation is rare, so some important considerations must be taken for surgical planning, positioning on the operating table, and rehabilitation. There are very few case reports described in the literature. We present the case of a patient with symptomatic stage III Tonnis hip osteoarthritis and a history of contralateral external hemipelvectomy, who underwent total hip replacement. Preoperative planning, surgical technique, and 6-year follow-up are described.

Liver Transplantation for Acute Liver Failure During Pregnancy: Case Report and Literature Review

Liver failure during pregnancy is a rare and highly fatal condition frequently resulting from the patient's pre-existing chronic liver disease. There is no established protocol for managing this condition, and physicians tend to adopt a conservative approach due to concerns about the impact of liver transplantation on fetal development. However, conservative treatment may exacerbate the condition, increasing the risk of fetal and miscarriage deaths. In this study, we present a case of acute-on-chronic liver failure resulting from chronic hepatitis during the 19th week of gestation. Despite undergoing conservative treatment, the fetus tragically died, but the patient achieved an excellent clinical outcome after emergency liver transplantation. We also conducted a systematic review of the literature on liver transplantation during pregnancy from the last decade, examining the causes of liver failure and transplantation during pregnancy. Our research complied with the principles outlined in the Declaration of Helsinki and the Istanbul Declaration.

Modified Anterolateral Minimally Invasive Surgery (ALMIS) for Total Hip Replacement: Anatomical Considerations, Range of Motion and Clinical Outcomes.

Background and Objectives: In the modified anterolateral minimally invasive surgery (ALMIS) for total hip arthroplasty (THA), the intermuscular plane between the tensor fasciae latae and the gluteus maximus (GM) is exposed, while the anterior ¼ of the GM is detached. There are scarce data regarding this surgical approach. The purpose of the present study is to thoroughly describe this approach, encompassing the anatomical background, and to present the results of a retrospective two-center study of 603 patients. Materials and Methods: The present study includes a two-center retrospective observational cohort of 603 patients undergoing the ALMIS technique with minimum 5-year follow-up. Demographics were recorded, while range of motion (ROM) of the hip joint and the Harris Hip Score (HHS) were evaluated preoperatively, at 1, 3 and 12 months postoperatively and at the final follow-up (>5 years). Surgery-related complications were also recorded. Results: The studied population's mean age was 69.4 years, while most of them were females (397; 65.8%). The mean follow-up was 6.9 years. The median HHS at the 1-month follow-up was 74, compared to the 47 preoperatively (p-value < 0.0001). At the final follow-up, median HHS was 94. At the 1-month follow-up, mean adduction was 19.9° (compared to 15.4° preoperatively; p < 0.0001), mean abduction 24.3° (18.2° preoperatively; p < 0.0001), mean flexion 107.8° (79.1° preoperatively; p < 0.0001), mean external rotation 20.1° (12.1° preoperatively; p < 0.0001) and mean internal rotation 15.3° (7.2° preoperatively; p < 0.0001). ROM further improved until the final follow-up; mean adduction reached 22°, mean abduction 27.1°, mean flexion 119.8°, mean external rotation 24.4° and mean internal rotation 19.7°. Regarding complications, 1.3% of the sample suffered anterior traumatic dislocation, in 1.8% an intraoperative femoral fracture occurred, while 1.2% suffered periprosthetic joint infection. Conclusions: The modified ALMIS technique exhibited excellent clinical outcomes at short-, mid- and long-term follow-up, by significantly improving hip ROM and the HHS. Careful utilization of this technique, after adequate training, should yield favorable outcomes, while minimal major complications should be expected.