Failure Of Surgical Intervention Research Articles

Nanofiber Graft Therapy to Prevent Shoulder Stiffness and Adhesions after Rotator Cuff Tendon Repair: A Comprehensive Review.

Stiffness and adhesions following rotator cuff tears (RCTs) are common complications that negatively affect surgical outcomes and impede healing, thereby increasing the risk of morbidity and failure of surgical interventions. Tissue engineering, particularly through the use of nanofiber scaffolds, has emerged as a promising regenerative medicine strategy to address these complications. This review critically assesses the efficacy and limitations of nanofiber-based methods in promoting rotator cuff (RC) regeneration and managing postrepair stiffness and adhesions. It also discusses the need for a multidisciplinary approach to advance this field and highlights important considerations for future clinical trials.

Charge transfer of ZnTPP/C60 cocrystal-hybridized bioimplants satisfies osteosarcoma eradication with antitumoral, antibacterial and osteogenic performances

Inferior bone-tissue regeneration, rapid tumor recurrence, and severe bacterial infection are the dominating challenges of osteosarcoma resection, which result in the failure of surgical intervention, and even amputation in serious circumstances. Herein, the multifunctional scaffolds (termed as ZCBS) are elaborately designed by in-situ integration of two-dimensional (2D) cocrystals with bioactive-glass scaffolds (BS) for significant osteosarcoma ablation, bacterial sterilization, and neo-bone regeneration. The efficient charge transfer between electron donor (zinc (II) tetraphenylporphyrin, ZnTPP) and acceptor (fullerene, C60) molecules of 2D cocrystals facilitates ZCBS with prominent photothermal-conversion performance for osteosarcoma elimination and bacterial eradication. Meanwhile, the gradual release of C60 and Zn2+ is beneficial to the reinforced antibacterial capability of ZCBS. Furthermore, the macropore structures and progressive release of Zn2+, Ca2+, and PO43- endow ZCBS with excellent osteogenic performance in promoting bone-tissue regeneration. Collectively, the engineered ZCBS bioscaffolds feature intrinsically multifunctional properties including antitumor, antibacterial, and osteogenic bioactivities, which support ZCBS for efficient osteosarcoma eradication, antibacterial treatment, and bone-tissue regeneration both in vitro and in vivo. Therefore, the developed “cocrystal engineering” strategy towards ZCBS with multifunctional bioactivities offer a competitive approach for osteosarcoma- and bacterial infection-induced bone regeneration.

Coblation supraglottoplasty: a ten-year experience in a tertiary referral hospital.

The present study aims to review the outcomes of coblation supraglottoplasty performed for children with different types of laryngomalacia, and we discuss the factors affecting these outcomes. We retrospectively reviewed the medical records of laryngomalacia patients admitted to the Otorhinolaryngology Department, Mansoura University, from 2010 to 2020. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, oxygen saturation, and final outcomes. Our study included 235 patients; 122 patients responded to medical therapy, while 113 underwent surgical management. There is a significant relation between the types and therapy they underwent (p ≤ 0.001). Larger percentage within type I underwent medical therapy. There is a statistically significant difference between the studied groups regarding age at surgery. On pairwise comparison, patients with type II had the lowest age significantly at the surgery when compared with each other individual group (p ≤ 0.001). On multivariate regression analysis, the presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention by 17.32 and 5.803 folds, respectively. Coblation supraglottoplasty is effective and safe to treat severe laryngomalacia. Different morphological types of laryngomalacia require slight surgical variations of coblation supraglottoplasty. The presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention.

INCREASING IMAGE SLICE ACQUISITION DECREASES ARTIFACTS GENERATED BY DIFFERENT ROOT-END FILLING MATERIALS

Background After endodontic surgery, radiographic assessment is the method of choice to monitor healing of bone defects. Cone beam computed tomography (CBCT) scans are useful to identify the cause of failure of surgical intervention or to confirm healing; however, the artifacts generated by some root-end filling material might compromise this objective. Objective To compare the artifact generated by 4 root-end filling materials at 2 slice acquisition settings—180 and 360 degrees. Hypothesis: Irrespective of the material used, artifacts generated with a 360-degree acquisition will be less than the artifacts generated by a 180-degree acquisition. Materials and Methods Twelve central incisors were endodontically treated, obturated, and then retrograde filled by using amalgam, Biodentine, mineral trioxide aggregate (MTA), and super–ethoxy benzoic acid (Super-EBA) (3 of each). A phantom was created; then, tooth samples were inserted and scanned in the center of a 4 × 4 mm field of view (FOV) by using a Morita MCT-1 F8 set at 90kV. Two scan mode settings were used (360 and 180 degrees), the volume CT dose index (CTDIvol) was registered, and the effective dose was calculated. Images were analyzed by using the Image J software to calculate the artifact generated. Results At 90kV, there was a statistically significant decrease in artifact generated by 360-degree scans versus the 180-degree scans regardless of material used (P value = .0001). Furthermore, amalgam generated a statistically significant increase in artifact compared with the other materials (P value Discussion Use of the 360-degree image slice acquisition mode generated significantly less artifact than the 180-degree setting for all materials; also, Biodentine, MTA, and super-EBA are biomechanically adequate for retrograde obturation because they generated significantly less artifact compared with amalgam. However, because exposure is nearly doubled by doubling image slice acquisition, further investigation at lower kV settings is prudent to find a lower dose alternative with similar statistically significant results.

The Social Science of Surgery: Commentary on an article by Yu Tang, MD, et al.: "Effect of Surgery on Quality of Life of Patients with Spinal Metastasis from Non-Small-Cell Lung Cancer".

Metastatic disease of bone is a major health problem across all cultures and socioeconomic levels. Care and treatment recommendations are best provided by multidisciplinary care teams. The role of the orthopaedic surgeon in these teams involves making decisions about when and when not to perform surgical treatment. However, the goals are quite different from those of most orthopaedic procedures. As Tang et al. noted, palliation, not cure, is the objective and thus quality of life becomes paramount in an assessment of the success or failure of surgical intervention. Despite increased clarity regarding surgical indications and documentation of neurologic improvement and pain relief, there is a paucity of literature on overall quality of life after surgical intervention for metastatic disease of bone involving the spine. Tang et al. present an observational study of …

P82 What is the role of chest computed tomography in children with parapneumonic effusion?

IntroductionThe incidence of parapneumonic effusion in children has been rising in the UK since the mid 1990s (1). There is anecdotal evidence that the number of complicated cases with more...

Preservation of fertility following abnormally adherent placenta treated conservatively: a case report

IntroductionOne of the ensuing complications of placenta accreta includes loss of fertility.Case presentationAn Asian origin Indian national patient with history of placenta accreta at the time of previous delivery and had conservative management with injection methotrexate after the failure of surgical intervention, conceives again and has uneventful antenatal period and parturition.ConclusionConservative strategy of leaving the excessively adherent placenta in-situ alongwith adjuvant therapy in the form of injection methotrexate, not only prevents dreadful complications but also retains fertility in haemodynamically stable patients desirous of future pregnancy.

RESPONSE SHIFT IN OUTCOME ASSESSMENT IN PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY

Background: A response shift is a psychological change in one's perception of the quality of life following a change in health status. This phenomenon initially was recognized in patients with terminal diseases who, despite a worsening of the physical condition, did not necessarily report deterioration in quality of life. The purpose of the present study was to examine the role of response shift in patients undergoing total knee replacement surgery. Methods: Consecutive candidates undergoing total knee replacement for the treatment of degenerative arthritis completed a Western Ontario and McMaster Universities Osteoarthritis questionnaire preoperatively (Pre-Test). At six months postoperatively, the patients completed two questionnaires: one on how they felt currently (Post-Test), and one on how they perceived themselves to have been prior to surgery (Then-Test). The study cohort comprised 125 subjects, including ninety-one women and thirty-four men, with a mean age (and standard deviation) of 68 ± 9.5 years. The impact of response shift was examined statistically. Results: With use of the Then-Test methodology, a significant (p < 0.05) response shift was observed in the domains of pain, physical function, and total Western Ontario and McMaster Universities Osteoarthritis score, indicating that patients perceived themselves as having been more disabled than what they had reported before surgery. In measuring outcome, this translates into the treatment effect being greater when adjusting for the presence of a response shift. With the numbers available, age, gender, comorbidity, and amount of recovery did not have a significant impact on response shift when adjusted for the preoperative level of disability. Conclusions: Patients who have undergone total knee replacement demonstrate a response shift in the measurement of their outcome at six months postoperatively. Although the response shift effect in the present study did not affect the interpretation of clinical results, we have highlighted the different patterns of individuals' psychological adaptation to a change in health status. This is an essential component of assessing the success or failure of surgical interventions as quantified with self-administered quality-of-life measures. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

Response Shift in Outcome Assessment in Patients Undergoing Total Knee Arthroplasty

A response shift is a psychological change in one's perception of the quality of life following a change in health status. This phenomenon initially was recognized in patients with terminal diseases who, despite a worsening of the physical condition, did not necessarily report deterioration in quality of life. The purpose of the present study was to examine the role of response shift in patients undergoing total knee replacement surgery. Consecutive candidates undergoing total knee replacement for the treatment of degenerative arthritis completed a Western Ontario and McMaster Universities Osteoarthritis questionnaire preoperatively (Pre-Test). At six months postoperatively, the patients completed two questionnaires: one on how they felt currently (Post-Test), and one on how they perceived themselves to have been prior to surgery (Then-Test). The study cohort comprised 125 subjects, including ninety-one women and thirty-four men, with a mean age (and standard deviation) of 68+/-9.5 years. The impact of response shift was examined statistically. With use of the Then-Test methodology, a significant (p<0.05) response shift was observed in the domains of pain, physical function, and total Western Ontario and McMaster Universities Osteoarthritis score, indicating that patients perceived themselves as having been more disabled than what they had reported before surgery. In measuring outcome, this translates into the treatment effect being greater when adjusting for the presence of a response shift. With the numbers available, age, gender, comorbidity, and amount of recovery did not have a significant impact on response shift when adjusted for the preoperative level of disability. Patients who have undergone total knee replacement demonstrate a response shift in the measurement of their outcome at six months postoperatively. Although the response shift effect in the present study did not affect the interpretation of clinical results, we have highlighted the different patterns of individuals' psychological adaptation to a change in health status. This is an essential component of assessing the success or failure of surgical interventions as quantified with self-administered quality-of-life measures.

Zur Effizienz von „Tensionfree Vaginal Tape“® (TVT) als Therapie von Harnstressinkontinenz bei hypotoner Urethra

Purpose: Patients with stress urinary incontinence at low urethral closure pressure, defined as maximum closure pressure equal or lower than 20 cm H 2 O, are at a higher risk for failure of surgical intervention. The aim of the study was to evaluate the objective healing and the changes of the urethral closure pressure of such women with severe urinary stress incontinence at hypotone urethra undergoing tension-free vaginal tape procedure. Material and Methods: Out of 150 patients who underwent TVT procedure between May 1999 and August 2000 because of urinary stress incontinence we found 29 of them with hypotone urethra. 25 of these were followed up in this study. Condition for enclosure was a positive stress test (leakage of urine like a jet at filled bladder with 300 ml while coughing as well in lying as in standing position) and a maximum urethral closure pressure lower or equal to 20cm H 2 O 4-6 weeks before surgery while performing urodynamic examination. 7 (4-12) months after surgery urodynamics and stress test were repeated. Healing was defined as negative stress test and regular maximum urethral pressure (higher than 20 cm H 2 O) at the time of control. Results: 19 (76%) patients had a negative stress test and a regular urethral pressure. At 4 (16%) women we found a negative stress test and still a hypotone urethra although maximum urethral pressure had risen but not up to 20 cm H 2 O. One (4%) patient still had a positive stress test with regular urethral closure pressure and one (4%) patient had a positive stress test as well as a hypotone urethra. Over all 23 (92%) patients had a negative stress test and were healed of urinary stress incontinence in all day situation. Conclusion: Our dates confirm TVT as a minimal invasive procedure to cure urinary stress incontinence in women with low pressure of the urethra.

An Outbreak of Multiresistant Salmonella typhi in South Africa

Typhoid fever caused by Salmonella typhi remains endemic to many parts of South Africa, including Natal and KwaZulu, Northern Transvaal and the Transkei. Until recently, the majority of S. typhi isolates from South Africa have remained susceptible to ampicillin/amoxycillin and chloramphenicol, and only three cases of typhoid due to multi-antibiotic resistant strains of S. typhi have been documented. Ampicillin/amoxycillin and chloramphenicol are, therefore, still recommended as first line therapy for patients with typhoid fever in this country. We describe a cluster of six cases of typhoid caused by S. typhi that was resistant to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. All these patients presented over a 3-month period; the patients were from three adjacent districts in the Northern Natal area of South Africa. The high rate of intestinal perforation (two of six) was a direct consequence of inappropriate antibiotic treatment. Failure of surgical intervention, renal impairment as well as delay in starting appropriate antibiotic treatment were factors contributing to the high mortality (three of six). The good clinical outcome in the remaining three patients probably resulted from treatment with appropriate antibiotics; however, mild disease in two of these patients may have been a contributing factor. All isolates showed high minimal inhibitory concentrations (MIC) of greater than or equal to 256 micrograms/ml to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. The isolates were all highly sensitive to the third generation cephalosporins (MIC less than or equal to 0.06 micrograms/ml) and quinolones (MIC less than or equal to 0.03 micrograms/ml). Conjugation studies suggest a genetic transfer of resistance, probably plasmid mediated. The presence of beta-lactamase and chloramphenicol acetyl transferase enzymes in all six isolates tested would account for the resistance to ampicillin and chloramphenicol respectively. The transfer of such plasmids to erstwhile sensitive strains could conceivably occur in this typhoid-endemic area, where sanitary conditions are poor and living conditions crowded, thus further exacerbating the problem. It is recommended that in areas where such multiresistant strains are encountered, the third generation cephalosporins or quinolones be used as empiric therapy for typhoid fever.

Flexion and Extension at the Hip

To the Editor:— Under date of Feb. 15, 1958, the report of a Committee on Medical Rating of Physical Impairment was published as a special supplement in The Journal. In describing the measurement of flexion-extension at the hip, it was stated that the total range of motion was 130° of which 30° resulted from hyperextension of the hip. This is in error both as regards the actual range of motion as well as the concept of hyperextension. Its validation by publication inThe Journalmust be contested, to minimize medical errors in reporting the success or failure of surgical interventions on the hip and medicolegal errors in evaluating the consequences of accidental injury to the hip. The mere use of the term hyperextention should have directed attention to the possibility of error. Almost 20 years ago, I noted, and my observations were later confirmed, that extension of the thigh with