Physical Examination Findings Research Articles

Prevalence and Clinical Characteristics of Pediatric Lower Airway Malacia: Case Series from a Tertiary Center in Turkey.

Introduction: Lower airway malacia (LAM) is characterized by a reduction in the cross-sectional luminal area during quiet respiration. There is no gold standard diagnostic test; however, flexible fiberoptic bronchoscopy (FFB) is most frequently utilized. The exact prevalence and incidence of LAM are unknown. This study aimed to determine the prevalence rates of pediatric patients diagnosed with LAM, offer a detailed understanding of their demographic and clinical characteristics, and investigate distinctions between two specific types of LAM, namely, tracheomalacia (TM) and bronchomalacia (BM). Materials and Methods: Patients younger than 18 years diagnosed with LAM using FFB were included in this retrospective case series. Demographic and clinical characteristics and comorbid disorders were compared between patients with isolated BM and those with isolated TM or tracheobronchomalacia (TM/TBM). Results: Among 390 patients who underwent FFB, 65 (16.6%) were diagnosed with LAM, 16 (24.6%) with TM, and 56 (86.2%) with BM. The median age at diagnosis was 15 months. Among them, 59 (90.8%) had other comorbidities; gastrointestinal (GI) disorders were the most common (38.5%). The most common indications for bronchoscopy were recurrent/prolonged lower respiratory tract infections (LRTI) or wheezing (43.1%), while the most frequently observed respiratory physical examination finding was stridor (35.4%). Patients with TM/TBM had significantly higher frequencies of premature births, stridor, retraction, and GI disorders. Conclusion: Patients with stridor without typical laryngomalacia features or recurrent or prolonged LRTI should undergo prompt evaluation for LAM. The potential coexistence of GI disorders such as gastroesophageal reflux disease and swallowing dysfunction should also be considered.

A Novel Treponema pallidum Subspecies pallidum Strain Associated With a Painful Oral Lesion Is a Member of a Potentially Emerging Nichols-Related Subgroup.

Early syphilitic lesions are typically painless; however, several recent case studies have included patients with tender lesions and no evidence of concurrent infections. Here we present the manifestations and serological and molecular findings of a patient from New York State with a painful tongue lesion. The diagnosis of syphilis was based on a combination of physical examination, serologic, pathologic, and immunohistochemical findings. DNA obtained from a formalin-fixed, paraffin-embedded biopsy was used to characterize the infecting pathogen using polymerase chain reaction, multilocus sequence typing, and whole-genome sequencing methods. Polymerase chain reaction and multilocus sequence typing of the biopsy specimen confirmed infection with T. pallidum subspecies pallidum ( T. pallidum ) of the Nichols cluster. Whole-genome sequencing analysis of this strain (herein called NYMC01) showed that it contained 17 unique single nucleotide variations and 4 more complex genetic differences; this novel genotype matched only 2 specimens, both from a patient in Seattle, Washington. The presence of this rare genotype in 2 geographically distinct locations suggests the potential emergence and spread of a new subgroup of the Nichols cluster. To our knowledge, this is the first genomic sequence obtained from a T. pallidum strain linked to a painful lesion, and the third description of whole-genome sequencing of T. pallidum from formalin-fixed, paraffin-embedded tissue. Analysis of additional specimens may reveal that the NYMC01-related genotype represents an emerging T. pallidum subgroup and may also aid in determining whether the painful clinical presentation of primary syphilis is related to specific T. pallidum genotypes.

Electrocardiographic Findings in Children Treated with Leuprolide Acetate for Precocious Puberty: Does it Cause Prolonged QT?

Central precocious puberty is treated with long-acting GnRH analogues. Some adult patients undergoing GnRHa treatment experienced prolonged QT syndrome, which is associated with an increased risk of serious cardiac events such as myocardial infarction, stroke, arrhythmias, and sudden cardiac death. Seventy-four patients, aged between 5 and 11 years and diagnosed with central precocious puberty but with no other concomitant disease or medication use, underwent electrocardiogram assessment. They had been receiving 3.75 mg leuprolide acetate (Lucrin® Depot) injections every 28 days for at least three months. The electrocardiograms of all patients showed a QTc interval within normal limits, consistent with the data of healthy Turkish children of the same age and gender. No other pathological physical examination or ECG findings were observed. Furthermore, there was no significant difference in QTc interval in relation to age, anthropometric data, or the duration or cumulative dose of the treatment. The study found no correlation between QTc interval values and age, treatment duration, total cumulative dose, and anthropometric data. The findings suggest that cardiovascular adverse events associated with GnRHa may be related to age and other underlying physiopathological conditions rather than the drug.

Understanding Abnormal Examination Findings During Concussion Recovery: A Retrospective Chart Review.

Physical examination findings in athletes with sport-related concussion (SRC) are not well described in the literature. The objective of this study was to describe physical examination findings during the first month following concussion in athletes, with a focus on the effect of sex, age, and time since injury. This was a retrospective electronic medical record (EMR) review of physical examination findings in 500 patients aged 6-24 who were initially seen within 15 days of SRC at a multidisciplinary outpatient academic concussion clinic between 2017 and 2019. A standardized concussion examination built in the EMR recorded mental status, cranial nerve, vestibulo-ocular motor screen, and balance findings for all patients. The primary outcome was the frequency of abnormal examination findings during the first 30 days postinjury, which was further analyzed by sex, age, and time since injury using mixed logistic regression models. The most common abnormal examination findings overall were eyes-closed single-leg stance, vestibular-ocular reflex, visual motion sensitivity, the neck examination, and eyes-closed tandem stance. Abnormal findings were more frequent in female athletes for vestibular ocular reflex and visual motion sensitivity. The frequency of abnormal findings increased with age for vestibulo-ocular reflex, visual motion sensitivity, the neck examination, convergence testing, and eyes-open single-leg stance, whereas abnormalities decreased in frequency with age for eyes-open tandem stance and tandem gait. The frequency of abnormal findings generally decreased with time over the first 4 weeks following injury. A comprehensive physical examination is pivotal for evaluation of athletes with concussion. These findings highlight high-yield components of the concussion examination and support use of these examination components as injury markers. Future work should investigate associations between physical examination findings and postconcussion symptoms and recovery outcomes. This retrospective cohort study provides Class IV evidence that neurologic examination with specifically designed clinical tests are helpful for diagnosis of traumatic brain injury in young athletes at age 6-24.

Gallbladder fossa lymphangioma encasing the common bile duct: a case report and review of the literature

Introduction: Lymphangiomas are rare low-flow lymphatic vessel malformations mostly diagnosed in childhood. Among the abdominal lymphangiomas, the gallbladder lymphangioma is a rare presentation, and only a few cases have been reported till date, of which majority were cystic lymphangiomas. Case presentation: The authors present a case of a 48-year-old female with abdominal pain and normal physical examination and laboratory findings. On the performed imaging, a multiloculated cystic lesion, located in the gallbladder fossa, was found. The patient underwent open cholecystectomy, and surprisingly, the cyst extended to the common bile duct, which was separated cautiously. The cyst was resected, and the histopathological findings confirmed cystic lymphangioma. Conclusion: The cystic lymphangioma of the gallbladder can be asymptomatic, although most of the literature has reported abdominal pain. The diagnosis of lymphangioma is complicated, especially when intra-cystic hemorrhage happens. Ultrasonography, computed tomography, and magnetic resonance imaging are usually performed. The surgical excision of the cyst and the gallbladder is the treatment of choice. Although bile duct involvement is extremely rare, it should be considered during the surgery.

Clinical Features and Therapeutic Process of Sacral Fatigue Fractures in Adolescents.

Sacral fatigue fractures are a rare injury but should be considered as a differential diagnosis for low back and buttock pain in young adults. Collective reports are limited, most of which have focused on long-distance runners. To investigate the characteristics of sacral fatigue fractures in adolescents. Case series; Level of evidence, 4. We analyzed patient background characteristics, physical examination and imaging findings, and treatment courses of those diagnosed with sacral fatigue fractures using magnetic resonance imaging. Among 34 patients with sacral fatigue fractures, 15 and 19 were male and female patients, respectively, with an age range of 11 to 19 years (mean age, 15.0 years). Almost all patients were athletes, and 29 patients performed their sport ≥5 times a week. Long-distance runners were the most commonly affected, comprising 7 patients, and participants in other common sports such as baseball (6 patients), basketball (4 patients), and soccer (3 patients) were also affected. Physical examination revealed tension sign (Lasègue test) on the affected side in 6 patients and tight hamstrings in 24 patients. Imaging findings included 18 patients with right-side involvement, 12 with left-side involvement, and 4 with involvement on both sides. In 11 patients, spina bifida occulta was observed at S1 and 8 patients had a history of lumbar spondylolysis with 4 patients having concurrent sacral fatigue fractures. Physical therapy was performed concurrently with the cessation of exercise, and return to exercise was permitted if the pain had been relieved after 1 month. All patients returned to sports at a median of 48 days (range, 20-226 days) after symptom onset. However, 2 patients experienced recurrence (1 patient on the ipsilateral side and 1 patient on the contralateral side). Sacral stress fractures are not limited to long-distance runners in this population and can manifest as lower back pain or buttock pain in athletes participating in a variety of sports. Although the course of treatment was generally good, the possibility of recurrence must always be considered.

Ultrasonographic Findings of Thyroid Parenchymal Disease

Thyroid parenchymal disease is an inflammatory disease that occurs in the thyroid parenchyma due to autoimmunity or infection. The differential diagnosis of thyroid parenchymal disease is based on clinical manifestation, physical examination, and serological findings. However, ultrasonography of thyroid has also a role in the diagnosis of thyroid parenchymal disease. This review describes common findings of ultrasonography in each thyroid parenchymal disease.

Upper Gastrointestinal Bleeding in the Emergency Department of Ibn Sina Hospital in Rabat: Etiological, Endoscopic, Therapeutic and Evolutive Aspects

Introduction: Upper gastrointestinal bleeding (UGIB) is defined as a bleeding from a lesion in the digestive tract located upstream of the duodenojejunal angle of Treitz. It is a medical emergency with a mortality ranging from 2 to 10%. The aim of the study is to investigate the main etiologies of upper gastrointestinal bleeding in our setting, and specify the main endoscopic findings, therapeutic approaches, and evolutive aspects. Materials and methods: A prospective, descriptive study conducted over an eight month period from May 1st to December 1st, including 50 adult patients admitted for UGIB who underwent conclusive esophagogastroduodenoscopy (EGD). We collected data about patients demographics, comorbidities, clinical presentaiton, physical examination findings, laboratory data, EGD results, therapeutic procedures and patient outcomes. Results: UGD represented 0.5% of emergency admissions, with a mean age of 61.22 years and no gender predominance. The main risk factors were related to the use of anticoagulants and/or antiplatelet agents, a history of chronic liver disease, chronic gastritis, and alcohol and tobacco use. Patients presented with hematemesis, melena, or both. EGD was performed in all patients, the main etiologies were peptic ulcer disease, vatical pathology and peptic pathology. Endoscopic treatment was performed in 38% patients, surgery was required in one case. Red blood cell transfusion was necessary in 83% patients. A favorable outcome was observed in 84% patients, while 16% patients died because of hemorrhagic shock, cardiogenic shock, and one case of multiple myeloma. Conclusion: UGIB remans a common medical and surgical emergency in our setting. The etiologies are dominated by peptic ulcer disease. EGD is the key investigation, with a diagnostic, therapeutic, and prognostic interest. The outcome was generally favorable in our study, except for 16% of cases who resulted in death. Preventive measures are essential.

Retroauricular endoscopic thyroidectomy: initial single-institution experiences.

Conventional thyroidectomy often results in visible scarring postoperatively. Endoscopic thyroidectomy offers the advantage of scarless surgery, especially beneficial for young adult women. The retroauricular approach uses a facelift incision well-known among surgeons and eliminates the need for gas insufflation due to the large working space. An early retrospective analysis was conducted on thirty-one individuals who underwent gasless retroauricular endoscopic thyroidectomy approach, focusing on isthmolobectomies (n = 26) and lobectomies (n = 5), with one case necessitating conversion to open thyroidectomy, from January 2016 to April 2017. Physical examination, laboratory, and histopathology findings were collected. The scar was evaluated using the Vancouver Scale System, while other surgical and oncological outcomes were documented and assessed. The average operative time was 154.2 ± 21.3min, with an average bleeding volume of 69.2 ± 52.1mL. The average length of stay was 4.7 ± 2.2days. All complications occurred were temporary and all subjects remained in good condition throughout the follow-up period. Most subjects (65.6%) were very satisfied with the scar concealed in the retroauricular area. Retroauricular endoscopic thyroidectomy is a safe and feasible remote access technique with excellent postoperative results.

Prognostic Value of B-Type Natriuretic Peptide in Hospitalized Patients with Pneumonia

Abstract Background: Pneumonia is a major medical problem and is foremost infectious cause of death in developed countries. A rapid and reliable predictor might aid physicians in identifying hospitalization, intensive care unit admission, and treatment changes. B-type natriuretic peptide (BNP) has consistently been observed to improve the diagnosis and management of hospitalized patients with pneumonia. This investigation aimed to study the importance of BNP in the assessment of severity of pneumonia in a tertiary care center in South India. Subjects and Methods: A hospital-based observational research was carried out on patients admitted during the period of September 2016 to July 2018 with sample size of 108. All patients satisfying the inclusion criteria were enrolled. Detailed clinical history and physical examination findings were noted. Diagnostic criteria symptoms were recorded following the standard protocol. BNP was measured using the double-antibody sandwich enzyme-linked immunosorbent assay. The statistical analyses were done using the statistical software R version 3.6.3 and MS Excel. Results: Out of 108 patients, 48 (44.44%) were female and 60 (55.56%) were male. Of these, 45 (41.67%) patients identified with community-acquired pneumonia, 27 (25%) with health-care-associated pneumonia, 26 (24.07%) with aspiration pneumonia, and 10 (9.26%) with pneumonia with comorbid conditions. BNP levels among survivors and nonsurvivors were 193.52 ± 124.93 and 413.08 ± 149.38 pg/ml, respectively. The total mortality was 13/108 (12.04%). Out of 13 patients, 12 (92.31%) nonsurvivors had BNP level ≥200 pg/ml and 1 (7.69%) had 100–200 pg/ml. Conclusion: BNP levels could be a useful single prognostic marker for pneumonia. BNP levels correlated with the clinical severity of pneumonia.

Clinical Presentation and Risk Stratification of Pulmonary Embolism

AbstractPulmonary embolism (PE) presents with a spectrum of symptoms, ranging from asymptomatic cases to life-threatening events. Common symptoms include sudden dyspnea, chest pain, limb swelling, syncope, and hemoptysis. Clinical presentation varies based on thrombus burden, demographics, and time to presentation. Diagnostic evaluation involves assessing symptoms, physical examination findings, and utilizing laboratory tests, including D-dimer. Risk stratification using tools like Wells score, Pulmonary Embolism Severity Index, and Hestia criteria aids in determining the severity of PE. PE is categorized based on hemodynamic status, temporal patterns, and anatomic locations of emboli to guide in making treatment decisions. Risk stratification plays a crucial role in directing management strategies, with elderly and comorbid individuals at higher risk. Early identification and appropriate risk stratification are essential for effective management of PE. As we delve into this review article, we aim to enhance the knowledge base surrounding PE, contributing to improved patient outcomes through informed decision-making in clinical practice.

Retrospective evaluation of traumatic pneumomediastinum in dogs and cats (2005-2022): 52 cases.

To describe the incidence, etiology, clinical signs, diagnostics, treatments, and outcome of noniatrogenic traumatic pneumomediastinum (TPM) in dogs and cats. Retrospective study of cases (2005-2022). University veterinary teaching hospital. Fifty-two patients (29 dogs, 23 cats). Data collected from the medical records included signalment, physical examination findings, animal trauma triage (ATT) score, clinicopathological data, imaging data, surgical intervention, length of hospitalization, supportive care, complications, and outcome. Most dogs presented with tachycardia and tachypnea, while cats presented with hypothermia and tachypnea. Subcutaneous emphysema, pneumothorax, and dyspnea were the most common clinical signs for both species. The median calculated ATT score was 3.5 in dogs and 4 in cats. The most common radiographic abnormalities other than pneumomediastinum were pneumothorax and lung contusions. The overall mortality rate was 18%, with a significantly higher survival rate in dogs (26/28 dogs [93%], 15/22 cats (68%); P=0.03). Outcome was unknown in 1 dog and 1 cat. The only significant difference in treatment between survivors and nonsurvivors was the requirement in dogs for positive pressure ventilation. The median hospitalization period was 2days for both species, with a shorter hospitalization in the nonsurvivors (0.6 vs 2days, respectively; P=0.006). TPM is an infrequent pathology in veterinary medicine and may be seen without an externally obvious injury. The most common causes for TPM in dogs were vehicular trauma and bite wounds, while high-rise syndrome was the most common cause in cats. Most of the cases have concurrent pneumothorax and require thoracocentesis; however, direct intervention to treat TPM is not usually required. The vast majority of cases did not undergo surgery to treat TPM. The prognosis for dogs with TPM was good but was guarded for cats.

Musculoskeletal mimics of lumbosacral radiculopathy.

Electrodiagnostic evaluations are commonly requested for patients with suspected radiculopathy. Understanding lower extremity musculoskeletal conditions is essential for electrodiagnostic medicine specialists, as musculoskeletal disorders often mimic or coexist with radiculopathy. This review delineates radicular pain from other types originating from the lumbosacral spine and describes musculoskeletal conditions frequently mimicking radiculopathy, such as those that cause radiating pain and sensorimotor dysfunction. In clinical evaluation, a history of pain radiating along a specific dermatomal territory with associated sensory disturbance suggests radiculopathy. Physical examination findings consistent with radiculopathy include myotomal weakness, depressed or absent muscle stretch reflexes, focal atrophy along a discrete nerve root territory, and potentially positive dural tension maneuvers like the straight leg raise. However, electrodiagnostic medicine specialists must be knowledgeable of musculoskeletal mimics, which may manifest as incomplete radiation within or beyond a dermatomal territory, non-radiating pain, tenderness, and give-way weakness, in the context of a normal neurological examination. A systematic approach to musculoskeletal examination is vital, and this review focuses on high-yield physical examination maneuvers and diagnostic investigations to differentiate between musculoskeletal conditions and radiculopathy. This approach ensures accurate diagnoses, promotes resource stewardship, enhances patient satisfaction, and optimizes care delivery. Musculoskeletal conditions resembling L1 to S4 radiculopathy are reviewed, emphasizing their distinctive features in history, physical examination, and diagnostic investigation. Among the more than 30 musculoskeletal disorders reviewed are hip and knee osteoarthritis, lumbar facet syndrome, myofascial pain syndrome, greater trochanteric pain syndrome, and plantar fasciitis.

Clinical Presentations and Risk Factors of Gastrointestinal Bleeding in the Emergency Department: A Multicenter Retrospective Study.

Gastrointestinal bleeding is a major healthcare burden and is associated with significant morbidity and mortality. This study aimed to assess the prevalence, clinical presentation, and risk factors of patients presenting with gastrointestinal bleeding in the emergency department. This retrospective study was conducted in two tertiary care hospitals in Riyadh, Saudi Arabia. The medical records of patients who presented to the emergency department with gastrointestinal bleeding between January 2010 and January 2020 were reviewed. Patients aged 18 years or older, with gastrointestinal bleeding (upper or lower) regardless of underlying cause, lifestyle, location of bleeding, health status, or medication use, were included. Demographic characteristics, initial vital signs, medical history, physical examination findings, comorbidities, medications, laboratory and radiological investigations, cause and stage of liver disease, management, and complications were recorded. Endoscopic findings and management of the bleeding site were collected according to the presenting symptoms. A total of 760 patients were included. The mean age was 62.7 ± 17.8 years, and 61.4% were males. The most common comorbidities at presentation were hypertension (54.1%), diabetes mellitus (51.2%), and ischemic heart disease (18.2%). The origins of the bleeding were lower gastrointestinal in 52%and upper gastrointestinal in 48% of patients. Lower gastrointestinal bleeding was found to be more common than upper gastrointestinal bleeding. Hemorrhoids, polyps, diverticular disease, and colonic ulcers were the major risk factors for lower gastrointestinal bleeding. In contrast, upper gastrointestinal bleeding was predominantly caused by esophageal varices, gastritis, and peptic ulcers.

Microsurgical treatment of ophthalmic artery aneurysm, a case series of 55 patients with long-term follow-up

BackgroundOphthalmic artery aneurysm (OAA) can be secured in endovascular or microsurgical approaches. Still there are controversies in technique selection and their long term outcomes.MethodsAll the patients with OAA were treated microsurgically and followed. Demographic data, neurological status, physical examination findings, angiographic data, operation details, and intraoperative and postoperative events were recorded and analyzed. P < 0.05 was considered significant.ResultsAmong 55 patients, 38 were females (69.1%). Median preoperative glasgow coma scale (GCS), Fisher Grade, and Hunt and Hess(HH) scores were 15, 1 and 1, respectively. The most common neurologic manifestation was visual problems (n = 15). The most common anatomical projection was medial (43.6%) oriented lesions. 85.5% of them only had 1 ophthalmic aneurysm while multiple aneurysms were reported in 14.6%. In 52 patients temporary clip was used. in 21 patients (38.2%) intraoperative aneurysm rupture occurred. Larger aneurysm size and preoperative hydrocephalus were associated with higher rates of aneurysm rupture (P = 0.003 and 0.031). 28.5% of the patients with visual problems had clinical improvement in the postoperative period. The mean follow-up period was 5 years. Follow-up angiography showed a 100% obliteration rate with a 0.0% recurrence rate. Median values for follow-up glasgow outcome scale and modified Rankin scale were 5 and 0, respectively. favorable neurological outcomes were associated with better primary GCS and HH scores.ConclusionOAA microsurgery is an effective and safe procedure with significant improvement in both visual and neurological status. Low recurrence rate and excellent clinical recovery are the most important advantages of microsurgery in OAA treatment.

Cubital Tunnel Syndrome Due to Intraneural Ganglion Cysts of the Ulnar Nerve With Joint-Cyst Connection at the Elbow

BACKGROUND AND OBJECTIVES: The unifying articular theory suggests that intraneural ganglion cysts in the cubital tunnel arise from the elbow joint and are connected to the ulnar nerve through an articular branch. This study aimed to report our clinical experience with these cysts and our surgical findings and outcomes. METHODS: We retrospectively analyzed 13 patients who underwent surgery for cubital tunnel syndrome caused by an intraneural ganglion cyst of the ulnar nerve. Clinical symptoms, physical examination findings, nerve conduction testing electromyography, plain radiography, and ultrasonography were evaluated before and after surgery. MRI was performed in 2 patients. Cyst decompression, disconnection of the articular branch, and ulnar nerve transposition were performed in all. RESULTS: The mean follow-up was 29 months. After surgery, local elbow pain and Tinel sign disappeared in all patients, and the average Numerical Rating Scale dropped from 3.7 (2-5) to 0 (0-0). Two-point discrimination testing was normal (&lt;5.0 mm) in 12 patients. Wartenberg sign and “claw hand” deformity became negative, and muscle function and motor nerve conduction velocity were improved in 12 patients. The Medical Research Council muscle strength grade was M4 or M5 in the flexor carpi ulnaris, flexor digitorum profundus of the 4th and 5th digits, and first dorsal interosseous muscle in 12 patients. Postoperative spontaneous potentials including fibrillation and sharp waves, and motor unit recruitment in the first dorsal interosseous muscle were obviously improved. A cystic articular branch was confirmed during surgery in all patients. No cyst recurred clinically or on follow-up ultrasonography. CONCLUSION: The unifying articular theory of intraneural ganglion cysts applies to those located in the ulnar nerve at the elbow. Surgical disconnection of the articular nerve branch from the ulnar nerve eliminated the pathway for cyst recurrence and achieved good long-term outcomes.

Clinical and research follow-up for knee cartilage injuries—an international consensus statement

PurposeThe purpose of this study was to establish consensus statements via a Delphi process on clinical and research follow-up for knee cartilage injuries. MethodsA consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-seven surgeons across 17 countries were invited to participate in these consensus statements. Nine questions were generated on clinical and research follow-up, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. ResultsOf the 9 total questions and consensus statements on clinical and research follow-up developed from 3 rounds of voting, 1 achieved unanimous consensus, 5 achieved strong consensus, 1 achieved consensus, and 2 did not achieve consensus. ConclusionThe statement that achieved unanimous consensus was on physical examination findings. The statements that achieved strong consensus were related to defining and monitoring treatment success, patient-reported outcomes, research follow-up, and second-look arthroscopy in the setting of recurrence. The statements that did not achieve consensus were related to routine imaging and length of clinical follow-up after operative intervention.

Tissue oxygen saturation is positively correlated with oxygen delivery and cardiac output in a canine hemorrhagic shock and resuscitation model.

To determine if tissue oxygen saturation (StO2) correlates with oxygen delivery (DO2) and/or cardiac output (CO) in a canine hemorrhagic shock model. 8 healthy purpose-bred dogs. Dogs were anesthetized, and hemorrhagic shock was induced by withdrawing up to 60% of total blood volume, targeting a mean arterial pressure (MAP) of 40 mm Hg. The withdrawn blood was returned to the patient in 2 equal aliquots. Data was collected at 4 time points: 10 minutes after MAP was stabilized under anesthesia (time point [TP]-1), 10 minutes after up to 60% of blood volume was removed to target a MAP of 40 mm Hg (TP2), 10 minutes after the return of 50% of shed blood (TP3), and 10 minutes after the return of the remaining 50% of shed blood (TP4). Total blood volume withdrawn, StO2, CO, heart rate, and MAP were recorded, and DO2 was calculated at each TP. Mean StO2 significantly decreased between TP1 (77.8% [± 9.54]) and TP2 (44.8% [± 19.5]; P < .001 vs TP1). Mean StO2 increased to 63.1% (± 9.85) at TP3, but remained significantly lower compared to TP1 (P = .002). There was no difference between mean StO2 at TP4 (82.5% [± 12.6]) versus TP1 (P = .466). StO2 has a strong, positive correlation to both CO (r = 0.80; P < .001) and DO2 (r = 0.75; P < .001). A decrease in StO2 may be used in conjunction with physical examination findings and diagnostic parameters to support a diagnosis of shock. The return of shed blood was correlated with increases in StO2, DO2, and CO, suggesting that StO2 may be used as a marker of adequate resuscitation.

Pit Viper Envenomation in Two Pregnant Bitches.

Snake envenomation is relatively common in small animals, particularly in endemic areas. Effects and outcomes of envenomation during pregnancy are poorly described in humans and more so in veterinary patients. Two young pregnant female dogs presented to a university teaching hospital with a history of acute soft tissue swelling and bleeding. History, physical examination findings, and diagnostics were consistent with envenomation by crotalid snakes. Medical management of one of the dogs included administration of antivenin. Both dogs survived envenomation with minimal complications and went on to whelp without complications, and all fetuses survived. This is the first description of the management of pit viper envenomation in pregnant dogs.

Randomized Trial of Single-incision Midurethral Sling and Laparoscopic Burch Colposuspension: Postoperative Surgical Outcomes and Complications

Various retropubic and midurethral sling techniques have shown high cure rates in the treatment of stress urinary incontinence (SUI). The aim of this study was to compare single-incision midurethral sling (SIMS), and laparoscopic Burch colposuspension (LBC) procedures in patients with SUI in terms of the effectiveness, patient satisfaction, surgical complications and results. This is a prospective randomised study. A university tertiary hospital PATIENTS: Forty patients with clinically and/or urodynamically proven SUI who agreed to surgical treatment were randomized to the SIMS and LBC groups and included in the study. Patients were treated with SIMS and LBC operations. Demographic characteristics of patients, physical and pelvic examination, preoperative and postoperative clinical findings, Kings Health Questionnaire (KHQ) form, Female Sexual Function Index (FSFI) and Prolapse Quality of Life Questionnaire (P-QoL) form, postoperative Day 1 Visual Analogue Scale (VAS) score, and postoperative complications were recorded. Objective and subjective success rates were recorded by re-evaluating the patients in the first and sixth months of the operation. Objective success was defined as having a negative stress test and subjective success was defined as the absence of stress-induced urine leakage after surgery in a validated questionnaire. The primary result of our study was considered to be objective success, while the secondary result was subjective success and life quality tests. Twenty patients each in the SIMS group and the LBC group were included in the study. No significant difference was found in objective success (90% vs. 85%, p=0.633) or subjective success (85% vs. 75%, p=0.695) between the two groups at 6-month follow-up. A significant improvement in life quality was observed in the postoperative period for both groups; however, the difference between the groups was not significant. There was an improvement in sexual function in both groups. Nonetheless, while this improvement was significant in the SIMS group, it was not significant in the LBC group. Additionally, surgery time, catheterization time and hospitalization time were shorter in the SIMS group than in the LBC group. The VAS score on postoperative day 1 was lower in the SIMS group. Groups were not different in terms of peroperative and postoperative complications. This preliminary study is the first randomized study which compares the LBC and SIMS procedures in the literature. It shows that SIMS and LBC procedures have not different objective and subjective success rates in the short term. It was also observed that they increase both sexual and life quality results in a positive and similar way.