Good Clinical Outcome Research Articles

Anterior Cruciate Ligament Reconstruction Utilizing Double Adjustable-Loop Suspensory Fixation Devices Provides Good Clinical Outcomes in Patients under the Age of 40 Years at Two-Year Follow-Up.

Background: Anterior cruciate ligament reconstruction (ACLR) using double adjustable fixation gained popularity in the last decade due to its minimally invasive technique. However, suspensory fixation devices could be related to recurrent instability, poor clinical outcomes, and patient dissatisfaction. The present study aims to evaluate the clinical outcomes following ACLR using double adjustable-loop suspensory fixation devices in the demanding population of young patients. Methods: Between 2019 and 2022, 95 patients with knee post-traumatic anterior cruciate ligament insufficiency were treated with primary ACLR using semitendinosus quadrupled graft and double adjustable-loop suspensory fixation devices and followed for at least two years. Concomitant lesions were also treated at the same surgical time. The knee examination form of the International Knee Documentation Committee (IKDC) was used to assess clinical evaluation, and the return to physical activities using the Tegner Activity Scale was recorded. Patient-reported objective measures (PROMs) were also evaluated, including the IKDC subjective and Lysholm scores. Results: Sixty-six males and twenty-nine females with a mean age of 23.8 (range 18-37) and a mean BMI of 24.9 (SD ± 2.42) kg/m2 were included in this study. All patients were evaluated clinically as normal or nearly normal at the final follow-up. PROMs also significantly improved postoperatively (p < 0.05) compared to the preoperative values. The Tegner Activity Scale increased from 2 to 7, the IKDC mean score improved from 43.9 (±8.9) to 93.3 (±12.3), and the modified Lysholm from 47.3 (±11.1) to 92.9 (±16.6). No complications or adverse events were recorded. Conclusions: Anterior cruciate ligament reconstruction utilizing double adjustable-loop suspensory fixation devices provides good clinical and functional outcomes in young patients at a two-year follow-up.

Clinical features, risk factors and outcomes of contact lens-related bacterial keratitis in Nottingham, UK: a 7-year study.

To examine the clinical characteristics, risk factors and outcomes of contact lens-related bacterial keratitis (CLBK) in a large UK tertiary referral centre. A retrospective analysis of all patients who presented to the Queen's Medical Centre, Nottingham, UK, with suspected CLBK between October 2015 to September 2022 (a 7-year period) was performed. Relevant data on demographic factors, CL wear behaviour, causes, clinical characteristics, and outcomes were analysed. We included 138 patients with CLBK; the mean age was 42.0 ± 17.8 years and 74 (53.6%) patients were male. Most CLBK were related to soft CL wear (94.5%), particularly monthly disposable (42.5%) and daily disposable (24.4%) CLs. Poor CL wear behaviour/hygiene was documented in 57.1% cases. Among the 64 (46.4%) microbiological-positive cases (n = 73 organisms), Pseudomonas aeruginosa (36, 49.3%) and Staphylococcus spp. (16, 21.9%) were most commonly identified. Six (4.3%) cases were polymicrobial. Most (97.0%) patients were successfully treated with topical antibiotics alone, with 80.6% achieving good final corrected-distance-visual-acuity (CDVA) of ≥ 0.30 logMAR. Poor visual outcome (final CDVA < 0.30 logMAR) was significantly associated with presenting CDVA < 0.6 logMAR (p = 0.002) and central ulcer (p = 0.004). Poor corneal healing (complete healing of > 30 days from initial presentation) was significantly associated with age > 50 years (p = 0.028), female gender (p = 0.020), and infiltrate size >3 mm (p = 0.031). Poor CL wear behaviour/hygiene is commonly observed in CLBK, highlighting the importance of improved counselling and awareness regarding CL use and hygiene. When presented early and managed appropriately, most patients are able to achieve good clinical outcomes with medical treatment alone.

Association of FOXL2 and ERCC6 variants with premature ovarian insufficiency and their potential use in clinical IVF guidance

Premature ovarian insufficiency (POI) is the main cause of infertility in women. Some cases of POI are thought to be caused by genetic defects and the clinical outcomes of these patients are unknown. Here, we performed whole-exome sequencing of the peripheral blood of a cohort of 55 subjects with POI and identified one heterozygous missense variant in FOXL2 (c.1045G>C; p.Arg349Gly) and two heterozygous missense variants in ERCC6 (c.379G>A; p.Val127Ile and c.4223A>C; p.Glu1408 Ala) in four POI patients. All of these heterozygous mutations were predicted to be deleterious and were parentally inherited from their heterozygous fathers. The mRNA and protein expression of FOXL2 and ERCC6 were absent or decreased in the patients. The patients carrying the variants of FOXL2 (c.1045G>C; p.Arg349Gly) and ERCC6 (c.379G>A; p.Val127Ile) failed to conceive in two and four assisted reproductive cycles, respectively. Another patient and her sister carrying the ERCC6 (c.4223A>C; p.Glu1408 Ala) variant achieved good clinical outcomes after assisted reproductive therapy. Our findings support the possible roles of FOXL2 and ERCC6 in POI and might contribute to the genetic counseling of POI patients.

High failure rate but promising clinical performance after implantation of a flexible medial meniscus prosthesis at 1-year follow-up.

After unsatisfactory results in a first-in-human clinical investigation with an anatomically shaped medial meniscus prosthesis, the prosthesis and its fixation technique were altered. This interim analysis of a prospective single-arm clinical investigation aims to evaluate safety and clinical performance in a first-in-human study with the redesigned meniscus prosthesis system. Ten patients suffering from medial postmeniscectomy pain syndrome were treated with the meniscus prosthesis. Patient-reported outcome measures were obtained at baseline and at 6-week, 3-, 6-, and 12-month follow-up. Radiographs and magnetic resonance imaging scans were obtained to evaluate joint degeneration and prosthesis location. The device alterations resolved the issues occurring with the previous design, but four prostheses were explanted after fixation failure or subluxation of the prosthesis. Five out of six patients who reached 1-year follow-up reported a clinically significant improvement of the knee injury and osteoarthritis outcome score pain subscale. Imaging revealed no adverse effects on joint degeneration. The failure mechanisms that occurred with the previous design have been resolved, but the new fixation technique introduced new safety issues. Improvement of positioning and fixation techniques are considered essential future adaptations to reduce the risk of failure. The good clinical outcomes reported by the patients reaching 1-year follow-up indicate that the medial meniscus prosthesis is a potential solution for patients suffering from postmeniscectomy pain syndrome. Level II.

Effects of thrombus characteristics on clinical outcome and success of recanalization in acute ischemic stroke

Background: Despite current developments in mechanical thrombectomy (MT), successful recanalization cannot be achieved in all patients. One of the factors related to this is the characteristics of the thrombus. In this study, we aimed to evaluate the effects of thrombus length and permeability on procedural success and clinical outcome. Methods: Patients with intracranial ICA, middle cerebral artery M1, or M2 occlusions, who underwent MT between November 2019 and January 2022 were included in the study. Thrombus length, density and permeability were calculated and the relationship between recanalization success and modified Rankin Scores (mRS) at the 3rd month was evaluated. Good clinical outcome was defined as an mRS score of 2 or less. Results: Forty-six of the 79 patients included in the study had a good clinical outcome. Although thrombus length was shorter and permeability was higher in patients with good clinical outcome, statistical significance was not achieved. There was a positive correlation between thrombus density, thrombus length and the number of passes, and a negative correlation between permeability. There was no significant difference in thrombus length, density and permeability between patients with and without successful recanalisation. Thrombus length was found to be a predictor of clinical outcome at 3 months in univariate analysis, whereas only age was found to be an independent predictor in multivariate analysis. Conclusions: In conclusion, despite certain findings not achieving statistical significance, the observed trends offer valuable insights for future research. A comprehensive understanding of thrombus nature could guide personalized stroke treatment strategies in the future.

Clinical outcome of surgically treated displaced acetabular fractures with central dislocation using combined anterior and medial plating

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim &amp;lt;/strong&amp;gt;Acetabular fractures are complex articular fractures with a big challenge for orthopaedic surgeons. Surgically managed displaced fractures carry favorable outcomes, especially if the articular surface is reduced accurately. This study aims to assess the clinical outcomes of surgical-ly fixed displaced acetabular fractures with central dislocation using combined anterior and medial plating.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods &amp;lt;/strong&amp;gt;We have retrospectively evaluated sixteen patients, who had surgically managed dis-placed acetabular fractures with central dislocation at our institute. All patients underwent open reduction and internal fixation using combined anterior and medial plating via the Kocher-Langenbeck, the ilioinguinal, or the Stoppa approach. The functional outcome was assessed using the Harris Hip score.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results &amp;lt;/strong&amp;gt;Our study includes sixteen patients (12 males, 4 females) with a mean age of 35 years (range: 15-53 years). The mean follow-up was 7.8 years (range: 5-13 years). Functional outcomes were good to excellent in 12 (80%) patients and fair in 3 (20%) patients. At the final follow-up, the solid union had been achieved in all fractures, the mean HHS was 88.84 &amp;amp;plusmn; 7.61.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion &amp;lt;/strong&amp;gt;Early reduction and surgical fixation of dis-placed acetabular fractures with central dislocation using combined anterior and medial plates appear to have good clinical outcomes.&amp;lt;/p&amp;gt;

Accuracy of placement of the glenoid component in reversed shoulder arthroplasty using a custom baseplate for severe glenoid deficiency

BackgroundGlenoid bone deficiency can lead to early component loosening and implant failure during reverse shoulder arthroplasty. Recently, the glenoid Vault Reconstruction System (Zimmer-Biomet, Warsaw, IN, USA), a computer-aided design/computer-assisted manufacturing system, was developed, with good clinical outcomes, including no radiographic loosening. This study examined the postoperative accuracy of glenoid component placement using this system at three different facilities. MethodsNine patients undergoing reverse shoulder arthroplasty with vault reconstruction system performed by three board-certified, fellowship-trained shoulder surgeons at three different institutions between August 2020 and January 2023 were included. Preoperative and postoperative computed tomography was performed, and glenoid inclination and version were measured using a postoperative three-dimensional evaluation system. Surgical time and intraoperative blood loss were also measured. ResultsThe range of errors of glenoid inclination and version were 3.5±2.5° (0.4–8.3) and 3.2 ±2.2° (0.4–6.7), respectively. In primary cases, the error ranges of both glenoid inclination and version were within 5° in six of seven cases (85.7%). In revision cases, both glenoid inclination and version were within 10°. The mean operative time was 131.4±48.9 (80–206) min and mean intraoperative blood loss was 161.1±94.2 (30–300) ml; there were no intraoperative complications. ConclusionIn the present study, the placement position was good in primary and revision cases, making the placement of the glenoid component of the reverse shoulder arthroplasty using vault reconstruction system in cases of glenoid bone deficiency highly reproducible.

Factors Influencing Long-term Outcomes After Matrix-Induced Autologous Chondrocyte Implantation: Long-term Results at 10 Years

Background: Matrix-induced autologous chondrocyte implantation (MACI), the third-generation of the technique, is an established procedure for the treatment of focal cartilage defects in the knee. However, the literature lacks long-term results of MACI with good statistical power. Purpose: To determine long-term survival and patient-reported outcomes (PROs) in a representative cohort and to identify patient- and surgery-related parameters that may influence long-term clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: A total of 103 patients were clinically evaluated at the current follow-up of 8.1 years (range, 5-11.9 years). PRO measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score (KOOS), EQ-5D, visual analog scale for pain, and Tegner Activity Scale. Magnetic resonance imaging results were evaluated by using the AMADEUS (area measurement and depth and underlying structures) and MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 knee score classification systems. Potential factors influencing PROs were first identified univariately and investigated in a multivariate regression model. Results: The defects had a mean size of 4.8 cm2 (range, 1.2-12 cm2) and were predominantly femorotibial (66%). The mean Kaplan-Meier survival rate of revision for any reason was 97.2% ± 1.6% at 10 years. In comparison to preoperative values, all PROMs were significantly improved at the current follow-up (P < .05). The MOCART 2.0 score peaked at 12 months (mean, 80.2 ± 15.3 months) and showed no significant change at 96 months (mean, 76.1 ± 19.5 months; P = .142). The linear multivariate regression model identified an association of body mass index (BMI), MOCART 2.0 score, and number of previous knee surgeries with KOOS (R2 = 0.41; f2 = 0.69). Further analysis of the individual determinants revealed an optimal BMI range of 20 to 29 for favorable PROs at 96 months. Significant correlations of MOCART subscores with the overall KOOS were found for graft surface and structure, bony reaction, and subchondral detectable changes. Only 30% of patients with2 previous surgeries and 20% of patients with 3 previous surgeries achieved a Patient Acceptable Symptom State (χ2 = 10.93; P = .012). Conclusion: The present study shows consistently good long-term clinical outcomes after MACI with a low revision rate and high patient satisfaction. BMI and number of previous knee surgeries may influence clinical outcomes and should be considered in patient selection and education. There is a correlation between graft structure, subchondral bone changes on magnetic resonance imaging, and long-term PROMs.

Performance and clinical outcomes in telestroke remain robust during the COVID-pandemic: insight into the NEVAS network.

The COVID-19 pandemic had significant impact on global healthcare, including stroke management. Telemedical stroke networks have emerged with positive results for patient outcome in rural areas without stroke expertise. However, telestroke faced enormous on-site challenges during the pandemic. So far, data on performance and clinical outcomes in telestroke settings during the COVID-pandemic are scarce. We retrospectively analyzed data from stroke patients treated in four spoke hospitals of the Bavarian telestroke network NEVAS in 2020-2021 and 2019 as reference year and compared the 3years for various parameters. Primary outcome was functional outcome according to the modified Rankin scale (mRS). Secondary outcome parameters included time intervals, periprocedural intracranial hemorrhage rates, and mortality. In 2019-2021, 2820 patients were treated for acute ischemic stroke with an admission decrease of 10% during the pandemic. Of those, 241 received only IVT and 204 were transferred to our center for MT. Door-to-imaging, door-to-needle, and symptom-onset-to-groin times remained comparable in the 3years. Complication rates remained at a low level. Good clinical outcome rates (mRS 0-2) at discharge remained stable for all stroke patients (82-84%) and for those treated with IVT (64-77%). Good clinical outcome rates at 3month follow-up for MT patients declined in 2020 (23% vs. 35% in 2019) but recovered again in 2021 (42%). Mortality rates did not increase for all patient groups analyzed. Stroke care remained robust during the COVID-pandemic within our network, indicating that well-established telestroke networks can overcome unexpected critical challenges such as a pandemic, guaranteeing best practice stroke care in rural areas.

Dissecting and fusiform aneurysms of the superior cerebellar artery: anatomy, clinical presentation, and treatment outcomes.

The management of superior cerebellar aneurysms is still controversial. Although several techniques are available, the deep localization of the lesion and the limited number of cases increase the complexity of decision-making for optimal treatment. Only a few cases of dissecting and fusiform aneurysms of the superior cerebellar artery (SCA) are described in the literature, many of which are without long follow-ups. The study aims to offer an exhaustive retrospective analysis of patients affected by SCA fusiform and dissecting aneurysms treated at our institution from 2008 to 2023, highlighting outcomes and complications. Moreover, a comprehensive narrative review was performed. A total of seven patients were treated at our institution. After a title and abstract screen, fifty-five papers met the criteria for inclusion in the review. In our case series, conservative treatment was proposed as the first therapeutic option in four cases (57.1%), while endovascular treatment (EVT) was in three cases (42.9%). A good recovery was observed in 66% of patients presenting with subarachnoid hemorrhage (SAH), while every patient without SAH achieved a good clinical outcome. A poor outcome was observed only in one patient with a dissecting aneurysm causing SAH, who also suffered a pontine infarction. In the literature review, conservative treatment was proposed as a first therapeutic option in eleven cases (16.6%), open microsurgical techniques in 19 patients (28.8%), and EVT in 31 patients (46.9%). Fatal outcome was documented in five patients (7.5%), all characterized by the rupture of the vascular lesion, while 6.1% of cases had non-fatal poor outcomes.

Updates in Management of Pulmonary Hypertension in Pediatrics: A Systematic Review

Objectives: To provide an updated synthesis of the evidence on the management of pulmonary hypertension (PH) in pediatric patients. Methods: We performed a thorough search of electronic databases such as PubMed, Science Direct, Cochrane Library, and Scopus. Two independent reviewers evaluated and retrieved information from qualifying papers. Results: Our data consists of eight studies with 2003 children, 930 (46.3%) of whom were female. Prostacyclin agonists were found to significantly improve hemodynamic parameters and reduced BNP levels, which implies that they have promising clinical efficacy and a good tolerance profile. No major side effects were noted except for headaches and gastrointestinal symptoms. Systemic glucocorticoids, inhaled NO, endothelin receptor antagonists, and PDE showed tolerability and clinical improvements in pediatric PH. Side effects such as acute kidney damage, renal failure, and methemoglobinemia were noted with the inhaled NO. Conclusion: Pediatric PH is still a difficult condition with high morbidity and mortality. All of the reported pharmacological interventions demonstrated good clinical outcomes and almost no adverse effects. Healthcare practitioners can improve the care of children with PH and eventually improve their quality of life and long-term survival by incorporating new research into clinical practice.

Reconstructing Quadriceps Tendon Disruptions in Post Total Knee Arthroplasty Patients with an Autogenous Peroneal Tendon Graft: A Viable Alternative.

Quadriceps tendon disruption post-total knee arthroplasty (TKA) is rare. Existing reconstruction procedures use allografts or synthetic meshes with varied success. This study evaluates outcomes with autogenous peroneal tendon grafts, a cost-effective alternative, compared to synthetic polypropylene mesh for quadriceps reconstruction. 16 patients who underwent extensor mechanism reconstruction between 2017 and 2021were retrospectively analysed. Parameters evaluated included type of reconstruction, extensor lag, IKDC (International Knee Documentation Committee) Score and AOFAS-Hindfoot-score (American Orthopaedic Foot and Ankle Society). At final follow-up, extensor lag for peroneal autograft group was 6.6° ± 1.5 and for synthetic polypropylene mesh group, 7.2° ± 0.7. Both groups improved in IKDC score (p < 0.01) AOFAS-Hindfoot-score was comparable for peroneal autograft patients with opposite side (p = 0.15). Autogenous peroneal tendon graft for quadriceps reconstruction could be viable, cost-effective alternative to allografts or synthetic meshes, with good clinical outcomes. Graphical abstract depicting the harvesting of the peronei grafts and their passage through the quadriceps tendon. Sonographic image showing the preoperative presence of a gap in the quadriceps tendon which is reconstructed post-operatively. The online version contains supplementary material available at 10.1007/s43465-024-01247-8.

Comparison of Modified Latarjet Procedure With Bone Graft Versus Standard Latarjet Procedure: Evaluating Outcomes and Stability.

The Latarjet procedure is a well-established technique for managing repeated anterior shoulder dislocation accompanied by massive glenoid bone loss. Aim of this article was to assess outcomes amongmodified Latarjet procedure using allograft from Iliac bone and a standard Latarjet procedure using the coracoid process. Six patients with recurrent anterior shoulder instability and significant glenoid bone loss were retrospectively analyzed. Three patients underwent the modified Latarjet procedure with iliac crest bone graft (Group A), and three underwent the standard Latarjet procedure (Group B). Outcomes were assessed at the 12-month follow-up, including shoulder stability, functional scores (Constant, the American Shoulder and Elbow Surgeons (ASES) score, and the Western Ontario Shoulder Instability Index (WOSI)), range of motion, complications, and return to sports. Both groups showed improvements in stability and functional scores, with no recurrent instability reported. Group A demonstrated slightly higher functional scores and range of motion. One patient in Group A experienced donor site pain, while one patient in Group B showed significant graft resorption. Graft union was achieved in all patients. Two-thirds of patients in each group returned to their pre-injury level of sports participation. Both techniques provided good clinical outcomes for anterior shoulder instability with glenoid bone loss. The modified Latarjet with iliac crest graft may offer slight advantages in functional outcomes and graft preservation but is associated with potential donor site morbidity. Larger, prospective studies are needed to definitively compare these techniques.

High relative cerebral blood volume is associated with good long term clinical outcomes in acute ischemic stroke: a retrospective cohort study

BackgroundEndovascular therapy for acute ischemic stroke has been shown to be highly effective in selected patients. However, the ideal criteria for patient selection are still debated. It is well known that collateral flow is an important factor, but the assessment is often subjective and time-consuming. Relative cerebral blood volume (rCBV) is a putative indicator of collateral capacity and can be quickly and easily determined by automated quantitative analysis. We investigated the relationship between rCBV of the affected region and clinical outcome in patients with acute ischemic stroke after endovascular therapy.MethodsWe conducted a retrospective study on consecutive patients between January 2017 and May 2019. Patients with acute ischemic stroke of the anterior circulation who underwent imaging including computed tomography perfusion and were treated with mechanical thrombectomy (MT) were eligible for inclusion. rCBV was calculated automatically with RAPID software by dividing the average cerebral blood volume (CBV) of the affected region (time-to-maximum (Tmax) > 6 s) by the CBV of the unaffected contralateral side. The primary outcome was determined by the modified Rankin Scale (mRS) after 90 days. Good clinical outcome was defined as mRS ≤ 2. We compared means, performed mono- and multivariate logistical regression and calculated a receiver operating characteristic (ROC)-analysis to determine the ideal cutoff value to predict clinical outcomes.Results155 patients were enrolled in this study. 66 patients (42.58%) had good clinical outcomes. Higher rCBV was associated with good clinical outcome (p < 0.001), even after adjustment for the patients’ status according to mRS and National Institute of Health Stroke Scale (NIHSS) age and Alberta stroke program early computed tomography score (ASPECTS) at baseline (p = 0.006). ROC-analysis revealed 0.650 (confidence interval: 0.616–0.778) as the optimal cutoff value.ConclusionHigher rCBV at baseline is associated with good clinical long-term outcomes in patients with acute ischemic stroke treated by MT. In this study we provide the biggest collective so far that gives evidence that rCBV can be a valuable tool to identify patients who might benefit from MT and are able give a threshold to help to offer patients MT in borderline cases.

A Narrative Review on Recombinant Human Bone Morphogenetic Protein 2: Where Are We Now?

Spinal fusion is a prevalent surgical intervention for degenerative spinal diseases, with increasing demand driven by ageing populations. The coexistence of multiple chronic conditions, termed multimorbidity, often complicates surgical outcomes, making advanced bone grafts crucial for successful fusions. This paper reviews the development, clinical application, and controversies surrounding the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in spinal fusion surgeries. A comprehensive narrative review was conducted, focusing on literature from January 1980 to January 2024, sourced from PubMed and Google Scholar. Studies included those examining rhBMP-2 specifically in spinal fusion contexts, excluding other bone morphogenetic proteins (BMPs) and non-spinal applications. This review presents an overarching synopsis of rhBMP-2, its development history and clinical efficacy, the emergence of side effects, and evolving patterns of clinical use. As discussed in this review, clinical practice has adjusted usage and dosages to mitigate adverse effects, yet the need for safer delivery mechanisms persists. rhBMP-2 remains a potent osteoinductive agent with comparable fusion success, as measured by radiographic fusion and good clinical outcomes, to autologous grafts but poses unique risks. This review sets out how further research is essential to optimise the delivery of rhBMP-2 to reduce side effects. Enhanced understanding and innovation of spatio-temporal presentation relative to endogenous BMP could significantly improve patient outcomes in spinal fusion surgeries. The review contributes to the growing body of literature on the use of rhBMP-2 in spine surgery and discusses changing patterns of clinical use over time.

Role of Chemoablation Using UGN-101 in Upper Tract Urothelial Carcinoma: A Systematic Review and MetaAnalysis of Available Evidence.

To examine the safety and efficacy of chemoablation using UGN-101 in patients with upper tract urothelial cancer (UTUC). We conducted a systematic search through 7 databases/registries to identify key observational and experimental studies reporting either the efficacy or safety of UGN-101 in UTUC patients regardless of the risk or grade of the disease. The outcomes included efficacy (complete/partial/no response, survival, death, recurrence, or progression) and safety endpoints. All meta-analyses were conducted through STATA. The prevalence rate and its 95% CI were pooled across studies. A subgroup meta-analysis was conducted on follow-up. The quality was assessed using the Newcastle Ottawa Scale. Twenty studies (1051 patients) were analyzed. Complete response was reported in 49% (39%-60%) of cases, and 5% (0%- 15%) had disease progression. Treatment cessation was reported in 13% (3%-27%) of patients. Four percent of cases needed radical nephroureterectomy. Recurrence and death occurred in 14% (7%-23%) and 6% (2%-10%) of patients. Complications occurred in 63% (39%-85%), the majority of which were of grades I, II, and III. Ureteral stenosis was the most common complication accounting for 35% of cases. Chemoablationrelated complications occurred more than procedure-related ones. Based on available evidence, the intracavitary instillation of UGN-101 gel provides an alternative therapeutic option for upper tract urothelial cancer. Chemoablation provides good clinical outcomes in terms of complete response, disease progression and recurrence, and the need to undergo nephroureterectomy. Complications were encountered in more than half the population; however, most of them were of low grades.

Same-day discharge coronary interventions: How to succeed?

Percutaneous coronary interventions(PCI) are the cornerstone of treatment in patients with coronary artery disease, generating substantial costs for the healthcare system. Considerable improvement in PCI technique, stent technology and antiplatelet therapy led to a complication rate of <5%, a success rate of >95% and lack of routine cardiothoracic surgical support. Thereby, the concept of same-day discharge following PCI has been proposed due to comparable efficacy, safety, and socioeconomic benefits to inpatient PCI. Although single-vessel disease was the primary indication for outpatient (OP) PCI, more complex scenarios such as multivessel disease, left main disease and chronic total occlusions were shown to be feasible and safe in OP setting as well. Currently available data shows that OP PCI leads to cost optimization, increased PCI center capacity, decrease in nosocomial infections rate and increased patient satisfaction, along with good clinical outcomes. Although OP PCI seems promising in a subset of well-prepared and compliant patients without severe comorbidities, there are some challenges to overcome before its routine implementation. To prevent unnecessary hospitalizations and unsafe same-day discharges, interventional cardiology teams should be trained to perform reliable risk-benefit assessments. Standardized forms should be created to obtain informed consent and instruct OP PCI patients and their relatives about postprocedural management. Here, we summarize the available data on OP and inpatient PCI outcomes, discuss the opportunities and challenges of OP PCI and propose a periprocedural patient management checklist, with the goal of facilitating OP PCI implementation in interventional cardiology centers.

Clinicopathological Findings and Comprehensive Review of Buschke-Lowenstein Tumors Based on a Case Study.

The Buschke-Löwenstein tumor (BLT), also known as giant condyloma acuminatum, is a rare, exophytic tumor, arising from pre-existing warty lesions associated with human papillomavirus (HPV) infection, particularly strains 6 and 11, which are considered to have low oncogenic potential. BLT presents as a large, cauliflower-like growth typically affecting the penis, vulva, vagina, perineum, scrotum, anus, and perianal area. Despite being a benign lesion, BLT is locally aggressive with a high recurrence rate, and can potentially undergo malignant transformation into squamous cell carcinoma, contributing to an overall mortality rate of 20-30%. The primary treatment is complete surgical excision with wide margins, frequently requiring complex reconstructive techniques for defect coverage. We report on a 68-year-old patient, with multiple comorbidities, who presented with a two-year history of a large exophytic tumor in the genital region, affecting the penis, along with progressive erectile dysfunction and urinary problems. The tumor was surgically excised with oncological safety margins, and reconstruction was performed using advancement and rotation flaps from the scrotum and intact penile skin. Histopathological examination confirmed the diagnosis of Giant Condyloma (Buschke-Löwenstein tumor), showing acanthosis, papillomatosis, parakeratosis, and koilocytic cell collections, with positive immunohistochemical staining for p16, p63, and ki67. Postoperatively, the patient had a good clinical outcome and a complete surgical cure. This case highlights the critical need for timely intervention and comprehensive management strategies in treating giant condyloma, given its potential for local invasion and substantial impacts on patient quality of life. Early diagnosis and thorough surgical excision are crucial for effective management and to reduce the high recurrence, morbidity and malignant transformation risk associated with this condition.

Surgery for subaxial cervical spine injuries: which is better: anterior, posterior, or anterior-posterior combined approach?: a systematic review and meta-analysis.

Both anterior and posterior approaches have shown insignificant differences in good clinical outcomes with one over another advantages and disadvantages. This review aimed to provide evidence for the best management of subaxial cervical spine injuries and discuss the clinical outcomes and complications. Clinical studies of anterior versus posterior and anterior versus anterior-posterior (combined) approaches to subaxial cervical spine injury were searched electronically from PubMed, Medline, ScienceDirect, Cochrane Library, and other Internet databases. Clinical improvement, complication rates, and mortality rates showed no significant differences with an odds ratio of 1.09 (95% confidence interval [CI], 0.79-1.49; p=0.61) for the anterior versus posterior approach and an odds ratio of 1.05 (95% CI, 0.35-3.18; p=0.93) for the anterior versus the combined approach. Surgical duration and blood loss were significantly different between the anterior and posterior groups with a mean difference of -42.84 (95% CI, -64.39 to 21.29; p<0.0001); -212.91 (95% CI, -417.60 to 8.22; p=0.04), respectively, whereas the length of hospitalization did not (p=0.16). No difference was found between the groups when compared by clinical improvement and complication rate. Meanwhile, the anterior approach was superior to the posterior approach in terms of surgical duration, blood loss, and hospitalization length.

Are positional screws superior to lag screws in fixation of medial malleolar fractures? A randomized controlled trial.

There is no consensus about the best fixation method for medial malleolar fractures. This study was conducted to compare the clinical and radiological results of positional (fully threaded) screws and lag (partially threaded) screws when used to fix medial malleolar fractures. This prospective, randomized clinical trial included 68 patients with closed isolated medial malleolar fractures. Each study arm included 34 patients who were randomly treated with either fully threaded screws (FT group) or partially threaded screws (PT group). Patients were evaluated radiologically for union and clinically using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score. After a 12-month follow-up, the mean AOFAS ankle hindfoot score was 92.1 ± 3.5 in the FT group and 91.8 ± 5.4 in the PT group. Union was achieved in the FT group after a mean of 6.2 ± 1.3 weeks and after a mean of 6.5 ± 1.5 weeks in the PT group. Both fully threaded and partially threaded screws yielded good comparable clinical and radiological outcomes when used to fix isolated medial malleolar fractures.