Gold Standard Method For Treatment Research Articles

Preoperative Factors Associated with Postoperative Diabetes Insipidus after Transsphenoidal Pituitary Adenectomy

Transsphenoidal pituitary adenectomy is the gold standard method of treatment of pituitaryadenomas. Post-operative diabetes insipid sis one of the common complication of this procedure. In this study we have analyzed pre-operative factors that may be associated with onset of diabetes insipid us following this procedure. A retrospective study of five years was conducted in a tertiary neurosurgical center. Histologically proven cases of pituitary adenomas who underwent transsphenoidalpituitary adenectomy were included in the study. Age and sex of the patients along with size and functional type of tumor were analyzed to see if they predicted the occurrence of diabetesinsipidus post-operatively. Out of 49 cases who underwent transsphenoidalpituitary surgery, 46 cases were proven to be pituitary adenomas histologically. There was male preponderance with male to female ratio of2:1. Age ranged from 15 to 72 with median age of 37 years. Nonfunctional, prolactinomas and growth hormone secreting tumors, were 25, 16and 4 in number. Median size of the tumor was2.35 in largest diameter. Out of these patients13 (28%) patients developed diabetes insipid us. Age, sex of the patient, size of the tumor and functional type of the tumor did not predict the incidence. Age, sex of the patient, size of the tumor and functional type of the tumor do not predict the incidence of diabetes insipid us post-operatively in patients undergoing transsphenoidal pituitaryadenectomy.

Gasless robotic perineal radical prostatectomy: An initial experience.

Radical prostatectomy (RP) is the gold standard treatment method of localized prostate cancer. Today, this surgery is performed with open or minimally invasive methods. The history of open perineal RP (RPP) is very old, but it is not often preferred by urologists. The use of robot-assisted laparoscopic RP (RALP) is very frequently applied today. Robotic perineal RP (r-RPP) by using a Gel-Point and insufflating CO2 into the perineal region was first described in 2014. In this case report, we report a 68-year-old patient with localized prostate cancer in whom we successfully performed gasless r-RPP, and according to our knowledge, this is the first case of gasless r-RPP to be reported.

Mid-long term follow-up of endovascularly treated intracranial aneurysms

Aim: Surgical clipping is the gold standard treatment method for the treatment of intracranial aneurysms, but endovascular therapy has become an alternative to surgical treatment for the last 30 years. In aneurysms treated with the endovascular method, recurrence may develop due to the mechanic failure of coil. The purpose of this study is; endovascularly-treated aneurysms follow up as planed. Material and Method: The study included 149 aneurysms of 130 patients treated and controlled endovascularly between January 2004 and December 2013. 72 of the patients were women, and 58 were males. Patients were between 13 and 81 years of age and the mean age was 50.9. Patients were followed for 6 to 84 months by magnetic resonance angiography and digital subtraction angiography. Morphological results were evaluated according to the Raymond classification. Raymond 1 (total occlusion), Raymond 2 (filling of the aneurysm neck) and Raymond 3 (residual aneurysm). Results: Raymond class 1 occlusion was obtained in 116 aneurysms treated with endovascular treatment (77.9%), Raymond class 2 in 16 aneurysms (10.9%) and Raymond class 3 occlusion in 17 aneurysms (11.4%). The total recanalization rate was 22.1%. Of 33 patients with Raymond class 2 and 3, 17 were diagnosed at the 6th month. The remaining 14 patients were diagnosed at the 1st year controls and 2 patients at the 2nd year controls. Of the 33 aneurysms with remnant-recurrence, 5 were giant aneurysms (> 25 mm), 14 were large aneurysms (10-25 mm), and 14 were small aneurysms (<10 mm). Conclusion: It is important to assess the stability of follow-up treatment after endovascular treatment and to detect early of recurrence. Many studies have reported that at least two controls should be performed within the first year after endovascular treatment. Long term follow-up is an appropriate choice to perform with magnetic resonance angiography.

An Alternative Method for Treating Exertional Heat Stroke: Tarp-Assisted Cooling

Exertional heat stroke, defined as a body temperature greater than 40°C to 40.5°C (104°F to 105°F) with associated central nervous system (CNS) dysfunction, is a medical emergency, and can lead to long-term complications or death without prompt recognition and proper care. Evidence shows that reducing body temperature below the critical threshold for cell damage (40.83°C) within 30 minutes of collapse ensures 100% survival without long-term sequelae.1–4 Evidence-based best practices clearly dictate that prompt assessment of body temperature using rectal thermometry and immediate, “cool first, transport second,” whole body cooling with cold water immersion is the standard of care for exertional heat stroke.5–7 However, what are clinicians to do if the gold-standard method of treatment, cold water immersion, is not feasible at the location where an exertional heat stroke occurs? The aim of this commentary is to provide clinicians with an alternative option for the treatment of exertional heat stroke in the event of cold water immersion not being available or feasible at a location where exertional heat stroke occurs.

Nerve allograft reconstruction of digital neuromata

Objective: A symptomatic digital neuroma may have a devastating impact on a person's life. There is no gold standard method of treatment. We hypothesise that the reconstruction of neuroma with nerve allograft will reduce the sensitisation and cortical reorganisation associated with peripheral nerve injury. In this study, we aim to assess the effect of neuroma reconstruction with nerve allograft on patient-reported pain and satisfaction. Methods: We conducted a retrospective review of patients who underwent nerve allograft reconstruction for painful digital neuroma at our unit, from July 2015 to July 2018. We measured pre- and post-operative visual analogue scale (VAS) pain scores, patient satisfaction and patient evaluation measure (PEM) scores. Results: In 10 patients, we reconstructed 12 neuromata. In nine of these patients (11 neuromata), we demonstrated a post-operative reduction in pain, with a change in median VAS score from 7.5 to 1. Patients were satisfied with their operation, with a median satisfaction score of 10/10. The procedure was unsuccessful in two patients, one with a static VAS score and one with a satisfaction score of

Outcome after 52 Salto Ankle Prostheses Implanted by a Single Surgeon.

While ankle arthrodesis was traditionally the gold standard method of treatment for disabling end-stage ankle arthritis, total ankle replacement (TAR) has been an acceptable alternative. The satisfaction rate of patients with TAR however differs. The purpose of our study is to investigate whether implant survival and results with special emphasis on the satisfaction rate of patients treated with a TAR implanted by a single surgeon were comparable to the literature. This was a retrospective cohort study in a teaching hospital. Data was collected from 52 patients who received a total ankle replacement (TAR) between 05/2002 and 06/2014. The mean follow-up time was 4.2 years (95% CI 3.3 – 5.0). Results showed a high satisfaction rate of 94% and 94% survival of the TAR after 5 years. We conclude that TAR with the Salto prosthesis is, in our hands, a reliable solution for end-stage ankle arthritis, with results comparable to the literature.

Hormonal therapies for hidradenitis suppurativa: Review

Hidradenitis suppurativa is a recurrent inflammatory skin condition characterized by abscesses and boils, predominantly in the groin, armpit, and buttocks areas. HS is not a life-threatening condition, but severely impairs quality of life in those affected. Finding a successful treatment approach for HS has been challenging, in part because of the lack of a gold-standard treatment method, limited research-based information, and the nature of clinical variation in the disease. Treatment commonly consists of antibiotics, anti-inflammatory therapy, hormonal therapy, and more invasive clinical procedures. Treatment is chosen by the degree of severity by which the condition presents and is modified accordingly. This review describes the roles of hormones in the pathogenesis of hidradenitis suppurativa and describes the use of hormonal therapy such as, finasteride, dutasteride, spironolactone, and oral contraceptives. The outcomes of the use of these modalities in various clinical studies are summarized.

Diaphyseal Fractures of the Forearm in Adults, Plating Or Intramedullary Nailing Is a Better Option for the Treatment?

BACKGROUND:Fractures of the radius and ulna occupy a large field of the modern traumatology. Therefore, these fractures are a major subject in modern orthopaedics and traumatology. The study of the mechanisms of the trauma, and the pathophysiological changes that occur are of great importance for the development of ever more efficient and varied ways of the treatment and prophylactics of this type of fracture.AIM:The aim of this paper was to study the pattern of the diaphyseal fractures of the forearm in adults, to decide the modalities of surgical management, to observe the period of fracture healing clinically and radiologically, as well to study the rehabilitation of the patients.MATERIAL AND METHODS:The present study included 45 cases of diaphyseal fractures of both bones forearm in adults presenting to the orthopaedic outpatient department. For all the patients a detailed history was taken. A thorough clinical examination was carried out, required X-rays were taken, and initial treatment was given and admitted as in all patients. After careful pre-operative planning and evaluation for anaesthetic fitness, patients were operated for the fractures of both bone forearms. Twenty-three cases with 46 fractures were treated by open reduction and rigid fixation with DCP & Semi-tubular plates and 22 cases with 44 fractures were treated by closed reduction and fixation with “Talwarkar” intramedullary square nails.RESULTS:United results were found in 100% of plating group vs. 86% in the nailing group. Delayed and non-union results were found in 9% of the nailing group only. Average time to union in weeks was 9.4 weeks in the plating group vs. 10.2 weeks in the nailing group.CONCLUSION:Open reduction and internal fixation with compression plates with strict adherence to surgical technique is the gold standard method of treatment in both bones forearm fractures with excellent results than closed reduction, internal fixation with “Talwarkar” square nails which is also again a simple method with better results than conservative methods.

Ultrasound guidance during hysteroscopic myomectomy in G1 and G2 Submucous Myomas: for a safer one step surgery

ObjectiveHysteroscopic myomectomy is the gold standard method for treatment of submucous fibroids. Hysteroscopic myomectomy techniques for removal of submucous fibroids still have controversies. In this study we aimed to describe usefulness of ultrasound guidance in hysteroscopic myomectomy for a safe and effective removal of submucous G1 and G2 fibroids. Study designThis is a multicentre study. 64 symptomatic patients with submucous fibroid underwent ultrasound guided hysteroscopic myomectomy. First we excised intrauterine dome of fibroid until reaching the level of cavity wall by the method of resectoscopic (electrosurgical resection using a loop electrode) slicing. Next remnant intramural node was squeezed by uterine contractions induced. After we had excised the intrauterine dome of fibroid by slicing method, we formed cavitation for the intramural part (newly raised myoma dome). The cavity was filled with distension solution and we evaluated the margins of the uterus and the margins of the myoma by sonographically. Then the myoma was excised under ultrasonographic guidance by transabdominal probe. We obtained a regular uterine cavity. ResultsMean operation time was 42±7min. Mean Mannitol volume was 4.3±1.7l and the mean intraoperational fluid deficit was 500ml. Not in any case uterine perforation was occurred. All fibroids removed totally. In 8 (19%) cases intrauterine synechiae detected and all these synechiaes were incised by a scissor during hysteroscopy. ConclusionThere is still no single technique proven to be unequivocally superior to the others for treating fibroids with intramural development (G1–G2). Ultrasound guided hysteroscopy seems to be an effective and safe method for resection of G1 and G2 fibroids.

Autologous Bone Marrow Stem Cells combined with Allograft Cancellous Bone in Treatment of Nonunion

Autologous cancellous bone graft is currently used as a gold standard method for treatment of bone nonunion. However, there is a limit to the amount of autologous cancellous bone that can be harvested and the donor site morbidity presents a major disadvantage to autologous bone grafting. Embedding viable cells within biological scaffolds appears to be extremely promising. The purpose of this study was to assess the outcome of autologous bone marrow stem cells combined with a cancellous bone allograft as compared to an autologous bone graft in the treatment of bone nonunion. Bone marrow aspiration concentrate (BMAC) was previously produced from bone marrow aspirate via a density gradient centrifugation. Autologous cancellous bone was harvested in 9 patients and applied to the nonunion site. In 18 patients of the clinical trial group after the debridement, the bone gaps were filled with a composite of BMAC and allograft cancellous bone chips (BMAC-ACB). Bone consolidation was obtained in 88.9 %, and the mean interval between the cell transplantation and union was 4.6 ± 1.5 months in the autograft group. Bone union rate was 94.4 % in group of composite BMAC-ACB implantation. The time to union in BMAC-ACB grafting group was 3.3 ± 0.90 months, and led to faster healing when compared to the autograft. A mean concentration of autologous progenitor cells was found to be 2.43 ± 1.03 (x106) CD34+ cells/ml, and a mean viability of CD34+ cells was 97.97 ± 1.47 (%). This study shows that the implantation of BMAC has presented the efficacy for treatment of nonunion and may contribute an available alternative to autologous cancellous bone graft. But large clinical application of BM-MSCs requires a more appropriate and profound scientific investigations.

Two-stage hip revision arthroplasty with a hexagonal modular cementless stem in cases of periprosthetic infection.

BackgroundTwo-stage revision arthroplasty is today regarded as the gold standard treatment method for deep prosthetic joint infection. The aim of the present study was to evaluate clinical and functional outcomes with the Modular Universal Tumor And Revision System (MUTARS) RS stem in patients undergoing two-stage revisions.MethodsThe functional and clinical outcomes for 43 patients who had undergone two-stage revision procedures for PJI were analyzed in a retrospective study. The minimum follow-up period was 24 months. Shorter follow-up periods were only observed when there were complications such as loosening or recurrent infection. The mean follow-up period was 3.86 years (range 7 months to 11.6 years).ResultsThe success rate with infection control for PJI was 93%. Reinfection occurred in four cases (7%). The risk of reinfection after MRSA infection was 20.5 times greater (P >0.01) than with sensitive or unknown bacteria. Two aseptic loosening occurred after 7 and 20 months. The average Harris Hip Score was 80 (range 62–93).ConclusionThis retrospective study showed a 93% rate of eradication using specific antibiotic therapy. With the modular MUTARS RS stem, there was a low rate of aseptic loosening of 4.6%. MRSA infection was identified as a risk factor for reinfection. The two-stage procedure with modular cementless implants used is therefore appropriate for treating periprosthetic infections associated with hip endoprostheses.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-398) contains supplementary material, which is available to authorized users.

Close Reduction and Percutaneous K-wire Fixation without Image Intensifier in Supracondylar Fracture of Humerus in Children

Introduction: Extension Type III supracondyla fractures of the humerus is most common fractures around the elbow in children. Closed reduction and percutaneous pinning under image intensifier guide has been the gold standard method of treatment. However, image intensifier is not readily available in most part of our country. Closed reduction and percutaneous pinning is possible even without image intensifier. we report our case series of 51 cases who underwent closed reduction and percutaneous pinning without image intensifier. Methods: Between November 2009 and April 2011 a total of 51 children with a displaced supracondylar fractures of the humerus were managed by close reduction and percuteneus k-wire fixation without using image intensifier. They were followed for a period of minimum 6 months up to one and a half years (average one year) and the final outcome was assessed using functional and cosmetic criteria used by Flynn and associates. Results: Of these 51 patients, 46 (90%) patients showed an excellent results. Satisfactory results were achieved in 4 (8%) patients, poor in 1(2%) patients. Conclusion: Close reduction and percutaneous K-wire fixation without using image intensifier is radiation free, cost effective and relatively safe method of management of displaced supracondylar fractures of humerus in children. It can be used in a remote hospital where the facilities of image intensifier or portable x-ray are not available. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9321 Nepal Orthopedic Association Journal 2013 Vol.3(1): 19-22

Locked Intramedullary Fixation vs Anatomically Contoured Locked Plating Of Clavicle Shaft Fractures – A Prospective Randomized Controlled Trial

Objectives:The treatment of displaced clavicle shaft fractures has evolved due to complications experienced by conservatively treated patients. Numerous operative modalities are available with various positive and negative aspects associated with each technique. This prospective randomized controlled trial compares the outcome of patients treated operatively with a novel locked intramedullary device and patients treated by traditional anatomically contoured locked plating.Methods:Patients with displaced and shortened clavicle shaft fractures were randomized according to presentation into 2 groups - intramedullary fixation and anatomically contoured locked plating. All patients were operated by the same surgeon with similar post-operative regimes for both groups. Outcomes accessed were DASH and Constant Shoulder scores at 6 weeks, 3 months and 6 months, scar size and quality, operative time, union rate and incidence of supraclavicular nerve injury at the time of surgery. Patients were assessed by the operative surgeon, a physiotherapist and an occupational therapist. Progression to union was assessed by a radiologist.Results:40 patients with 6 months follow-up were available for review - 20 in each group. No statistically significant difference in average DASH and Constant Shoulder scores at 6 weeks, 3 months and 6 months for the two groups were found. The surgical scars were smaller and the cosmetic result better in the intramedullary group. Operative time was significantly shorter in the intramedullary group. Both groups achieved a 100% union rate at 6 months post-op. The rate of supraclavicular nerve injury in the plating group was higher and most patients complained of prominent hardware.Conclusion:Locked intramedullary fixation of clavicle shaft fractures using the Sonoma CrX system was found to be a reliable method of achieving fracture reduction and fracture union. Shoulder function was restored and union achieved with a good cosmetic result. Supraclavicular nerve injury is rare and a second operation to remove prominent hardware is not necessary. Patient outcomes were found to be similar to that achieved by anatomically contoured locked plating - the current accepted gold standard method of treatment.

Atypical solitary fibrous tumor of the nose and maxillary sinus

Solitary fibrous tumor (SFT) belongs to a group of mesenchymal tumors, also known as benign fibrous mesotheliomas or submesothelial fibromas. SFTs of the sinonasal tract are extremely rare. We report a rare case of an atypical SFT of the sinonasal tract presenting with ipsilateral nasal obstruction and recurrent epistaxis. Endoscopy and imaging studies showed a well-circumscribed mass of the nose and the maxillary sinus. The patient underwent total endoscopic resection of the tumor. Permanent histology and immunohistochemical studies revealed an atypical variant of SFT of the sinonasal tract, with negative surgical margins. The patient did not receive any adjuvant treatment. Postoperative monitoring was uneventful. In general, these tumors are reported to follow an indolent course. SFTs adopt a biological behavior that cannot be determined as malignant. Total surgical resection of the tumor remains the gold-standard method of treatment.

Tibial Shaft Fracture after Removal of an ACE Tibial Nail

Intramedullary interlocking nailing is the gold standard method for treatment of tibial shaft fractures. Thus, the growing use of the intramedullary nailing resulted in an increased number of tibial nails removal procedures in daily clinical practice. Despite adequate surgeon experience, the removal of tibial intramedullary nails is not without complications. One of the commonly used nails is the ACE (DePuy Orthopaedics, Inc., Warsaw, IN, USA). The purpose of this paper is to report such a complication following the removal procedure and review the pertinent literature. A 39-year-old female who had sustained a lower-third tibial fracture was treated with an intramedullary nail 5 years ago. Despite her unremarkable follow-up, for personal reasons, a removal procedure was planned. Two undisplaced fractures were observed in the postoperative radiological evaluation. The potential complications of the removal of intramedullary nailing of the tibia should be considered by both physician and patient.