Good Clinical Results Research Articles

Case report of a multidisciplinary approach to one-time treatment of a patient with critical aortic valve stenosis, lesion of the left main coronary artery and bleeding stomach cancer

Aortic valve stenosis and bleeding gastric cancer are formidable diseases characterized by high mortality. For a long time, the gold standard for treating patients with aortic stenosis has been open-heart surgery — aortic valve replacement. However, the endovascular operation that appeared in 2002 — transcatheter aortic valve implantation (TAVI) has become the standard of care for patients with high surgical risk. Gastric cancer is one of the major severe oncological diseases in which surgery is the only way to cure. The combination of these two diseases significantly worsens the prognosis and is a difficult clinical task for choosing the optimal tactics for treating a patient. Given the lack of developed standards for the treatment of multimorbid patients, the treatment plan is determined by an interdisciplinary consultation. But with a combination of these diseases, there is no generally accepted approach in the known recommendations. The purpose of this report is to present a clinical case of a patient with critical aortic stenosis, concomitant severe coronary artery disease, and bleeding stomach cancer, who underwent a successful one-stage operation — percutaneous coronary intervention, TAVI and open gastrectomy with Roux-loop reconstruction with one anesthetic aid by the decision of a multidisciplinary team. The patient was discharged in a satisfactory condition. In the late follow-up period, angina pectoris returned with restenosis of the stent in the anterior interventricular branch (LAD), which required repeated intervention in the form of LAD restenting with a good clinical result. A hybrid approach in the treatment of patients with critical aortic valve stenosis in combination with coronary artery disease and bleeding gastric cancer can be accepted as one of the possible strategies, but further research is needed in this direction. Received 15 October 2021. Revised 20 January 2022. Accepted 31 January 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsLiterature review: N.L. Irodova, L.G. GeletsyanDrafting the article: N.G. Karapetyan, N.N. MeleshenkoCritical revision of the article: B.G. Alekyan, A.Sh. RevishviliSurgical treatment: B.G. Alekyan, D.V. Ruchkin, N.G. Karapetyan, N.N. MeleshenkoFinal approval of the version to be published: B.G. Alekyan, D.V. Ruchkin, N.G. Karapetyan, N.L. Irodova, N.N. Meleshenko, L.G. Geletsyan, A.Sh. Revishvili

Pure Ankle Dislocation Without Associated Fracture: A Series of Cases and Our Clinical Experience.

Pure ankle dislocation without associated fracture is extremely rare. The current study reports eight cases of this type of injury, aiming to add some new material to the published data and present our clinical experience. Six open and two closed posteromedial tibiotalar dislocations without associated fractures treated in our department from 2015 to 2019 were retrospectively analyzed. Emergent reduction was performed for all patients followed by an average of 6weeks of immobilization with external fixators in open cases and a short leg cast in closed cases. No patients underwent ligament or capsule repair except one case. The clinical data were recorded and analyzed. At a mean follow-up of 33months (range 13-61), the average AOFAS score was 91 (range 78-100) with five ankles rated as excellent and three rated as good. All of the eight patients returned to their prior daily life and the two closed patients with sports injuries resumed pre-injury activity level. The average range of motion (ROM) loss of the ankles was 9 degrees for plantarflexion and 3 degrees for dorsiflexion. Complications included superficial infection, moderate ankle stiffness, ankle degenerative change and residual numbness. None of the eight patients showed obvious ankle instability. Pure ankle dislocation without associated fracture is a rare injury. Emergent reduction, appropriate wound care in open injuries and proper joint stabilisation with a cast or external fixator provide good clinical results and could be the mainstay of treatment.

Metatarsus adductus setting in adult patients: Results of a treatment algorithm with shortening arthrodesis tarsometatarsal joints two and three

BackgroundThis study proposes a treatment algorithm based on the correction of symptomatic metatarsus adductus (MA) associated with hallux abducto-valgo (HAV) through tarsometatarsal joint 2–3 (TMTJ) shortening arthrodesis. Our hypothesis is that the proposed algorithm leads to realignment of the forefoot rays from two to five and reduction of the talonavicular coverage angle (TNCA) with good clinical and radiographic results. MethodsClinical and radiographic evaluations were performed before and after surgery at 1-year follow-up on forty-six consecutive adult patients with MA, midfoot pain, HAV and osteoarthritis and/or instability of the TMTJ 2–3 in whom shortening of the 2nd and 3rd TMT joints according to MAA and treatment of the HV according to deformity was undertaken. ResultsTalus-first metatarsal angle (TFMA) was the only parameter which did not statistically significantly postoperatively change. All other clinical (AOFAS score) and radiological outcomes significantly improved postoperatively. ConclusionAlthough further studies are needed to confirm the proposed data, it would seems that the shortening arthrodesis of rays two and three has consequences on the forefoot and hindfoot by realigning the longitudinal axis of the foot. The consequent application of the algorithm and adequate correction of the HAV allow good clinical and radiographic results to be obtained. Level of evidenceIV prospective cases series.

The Interventricular Septal Hematoma Following Surgical Correction of Ventricular Septal Defect in Infants: A Single-Center Experience.

To review and analyze the cases of interventricular septal hematoma (IVSH) following surgical correction of the ventricular septal defect (VSD) in infants in our center. Retrospective analysis was performed on five infants with IVSH after surgical correction of VSD in our center from January 2020 to January 2022. The general preoperative information and intraoperative and postoperative results were collected and analyzed. All five infants with VSD were repaired under cardiopulmonary bypass and occurred IVSH. The cardiac arrest occurred in one patient five hours after return to the intensive care unit (ICU). The patient's hemodynamics were difficult to maintain after cardiopulmonary resuscitation, and the patient died. Two other patients had arrhythmia and unstable hemodynamics during the perioperative period, the hematoma puncture was performed, and the patients' symptoms lessened. Perioperative and postoperative echocardiography showed that the hematoma gradually was shrunk, and the hemodynamics became stable. The hemodynamics were stable in the remaining two infants during the perioperative period. No specific medical intervention was required other than clinical observation in these two patients. Finally, the four infants successfully were discharged with good clinical results. IVSH is a rare complication of surgical repair of VSD. Prevention and early detection of IVSH during operation in infants with VSD are essential.

Reconstruction of the rectovaginal septum with a W-mesh for rectocele

Aim: to assess of late results of original method of rectocele repair with non-absorbable polypropylene W-form mesh. Patients and methods: the pilot study included 37 patients which underwent surgery for rectocele repair using original technique of W-mesh. The late results were assessed in 21 (56.6 %) of them ≥ 6 month after surgery. Before the surgery and 6 months after, patients underwent a clinical assessment of symptoms. Specialized questionnaires for assessment of constipation (Colonic evacuation disorder scale, PFDI-20, Cleveland Clinic Constipation Score) were used. Defecography and anorectal manometry were performed before and in 6-months after surgery for evaluation of pelvic floor disorders. Results: no obstructive defecation symptoms were revealed in 85.7% of patients 6 month after surgery.In ≥ 6 months after surgery all questionnaires showed decrease in scores by more than 2 times. Comparison of the results before and 6 months after the surgery showed significant differences for all questionnaires (p < 0.0001). According to defecography performed before and after the surgery a significant reduction (p < 0.05) of rectocele depth, time of rectal voiding (decreased by 1.5 times) and residual volume of contrast agent (decreased by 2.5 times) were revealed. There are no severe complications requiring re-operation were observed. Conclusion: transvaginal mesh repair of symptomatic rectocele demonstrated good clinical results 6 months after surgery. Good results were revealed in 85,7 % of patients confirmed by specialized questionnaires and defecography.

Clinical Analysis of Primary Tracheobronchial Tumors in Children and Evaluation of the Predicting Models for Mucoepidermoid Carcinoma.

To determine the clinical characteristics and prognosis of primary tracheobronchial tumors (PTTs) in children, and to explore the most common tumor identification methods. The medical records of children with PTTs who were hospitalized at the Children's Hospital of Chongqing Medical University from January 1995 to January 2020 were reviewed retrospectively. The clinical features, imaging, treatments, and outcomes of these patients were statistically analyzed. Machine learning techniques such as Gaussian naïve Bayes, support vector machine (SVM) and decision tree models were used to identify mucoepidermoid carcinoma (ME). A total of 16 children were hospitalized with PTTs during the study period. This included 5 (31.3%) children with ME, 3 (18.8%) children with inflammatory myofibroblastic tumors (IMT), 2 children (12.5%) with sarcomas, 2 (12.5%) children with papillomatosis and 1 child (6.3%) each with carcinoid carcinoma, adenoid cystic carcinoma (ACC), hemangioma, and schwannoma, respectively. ME was the most common tumor type and amongst the 3 ME recognition methods, the SVM model showed the best performance. The main clinical symptoms of PPTs were cough (81.3%), breathlessness (50%), wheezing (43.8%), progressive dyspnea (37.5%), hemoptysis (37.5%), and fever (25%). Of the 16 patients, 7 were treated with surgery, 8 underwent bronchoscopic tumor resection, and 1 child died. Of the 11 other children, 3 experienced recurrence, and the last 8 remained disease-free. No deaths were observed during the follow-up period. PTT are very rare in children and the highest percentage of cases is due to ME. The SVM model was highly accurate in identifying ME. Chest CT and bronchoscopy can effectively diagnose PTTs. Surgery and bronchoscopic intervention can both achieve good clinical results and the prognosis of the 11 children that were followed up was good.

Reconstruction of the cervical ligament in patients with chronic subtalar instability

PurposeDiagnosis and treatment of subtalar instability (STI) remains complicated and challenging. The purpose of this study was to investigate the outcome of an anatomical reconstruction of the cervical ligament in patients with suspected chronic STI. MethodsThis prospective study assessed the results of a surgical reconstruction of the cervical ligament using a gracilis tendon graft in a group of 14 patients (16 feet). Diagnosis of STI was performed using a predefined algorithm including clinical signs, MRI and peroperative evaluation. All patients had symptoms of chronic hindfoot instability despite prolonged non-surgical treatment. At final follow-up the outcome was assessed using the Karlsson score, the Foot and Ankle Outcome Score and the American Orthopaedic Foot and Ankle Society score. ResultsAfter an average follow up of 22.6 months (range, 15–36), all patients reported significant improvement compared to their preoperative symptoms. The mean preoperative Karlsson score improved from 36.4 ± 13.5 (median 37, range 10–55) to a mean postoperative Karlsson score was 89.6 ± 8.5 (median 90, range 72–100) (P < 0.0001). The cervical ligament reconstruction was combined with other procedures in 13 cases: calcaneofibular ligament (CFL) reconstruction (3), CFL and anterior talofibular ligament reconstruction (7), bifurcate ligament reconstruction (3). ConclusionAnatomical reconstruction of the cervical ligament is a valid technique to treat patients with STI. It is a safe procedure and produces good clinical results with minimal complications. This technique can be considered in more complex cases and can be combined with other procedures according to the specific location of the instability. Level of evidenceLevel III

Comparison of Two Endoscopic Therapeutic Interventions as Primary Treatment for Anastomotic Leakages after Total Gastrectomy.

Simple SummaryAn esophagojejunal anastomotic leak after oncological gastrectomy is a life-threatening complication. Endoscopic treatment offers the possibility of minimally invasive diagnosis and immediate effective therapy in one session. A retrospective, single-center analysis of two different endoscopic strategies as first-line treatment options was performed.Introduction: An esophagojejunal anastomotic leak following an oncological gastrectomy is a life-threatening complication, and its management is challenging. A stent application and endoscopic negative pressure therapy are possible therapeutic options. A clinical comparison of these strategies has been missing until now. Methods: A retrospective analysis of 14 consecutive patients endoscopically treated for an anastomotic leak after a gastrectomy between June 2014 and December 2019 was performed. Results: The mean time of the diagnosis of the leakage was 7.14 days after surgery. Five patients were selected for a covered stent, and nine patients received endoscopic negative pressure therapy. In the stent group, the mean number of endoscopies was 2.4, the mean duration of therapy was 26 days, and the mean time of hospitalization was 30 days. In patients treated with endoscopic negative pressure therapy, the mean number of endoscopies was 6.0, the mean days of therapy duration was 14.78, and the mean days of hospitalization was 38.11. Treatment was successful in all patients in the stent-based therapy group and in eight of nine patients in the negative pressure therapy group. Discussion: Good clinical results in preserving the anastomosis and providing sepsis control was achieved in all patients. Stent therapy resulted in anastomosis healing with a lower number of endoscopies, a shorter time of hospitalization, and rapid oral nutrition.

AN OVERVIEW OF THE MANAGEMENT OF ANKLE FRACTURES IN GERIATRIC POPULATION

Background : Recent clinical studies have identified a significant increase in the incidence and severity of ankle fractures in the elderly population. Kannus et al reported that between 1970 and 2000 there was a three-fold increase in the number of ankle fractures among Finnish patients over 70 years old [1]. In addition, the authors demonstrated an increase in the more severe Lauge-Hansen supination-eversion stage four fracture, compared to more stable ankle fracture patterns in this elderly patient population. In the data available from the United States, ankle fractures have been reported to occur in as many as 8.3 per 1000 Medicare recipients, a figure that appears to be rising steadily [2] . There continues to be controversy within the orthopaedic community regarding the optimal management of geriatric ankle fractures. Operative fixation has been proven to be a safe and effective method of managing unstable ankle fractures in younger patients [3 ] . However, certain authors have recommended conservative treatment in older patients, based on poor surgical outcomes secondary to osteoporosis, diabetes, peripheral vascular disease and skin issues commonly seen with advanced age [4, 5, 6, 7] . Recommendations on appropriate management also appear to differ based on geographical location, evidenced by a recent study by Koval et al [2] . The authors demonstrated that the percentage of ankle fractures in patients older than 65 treated with surgical stabilization varied considerably in various parts of our country. The current paper reviews the complex issues associated with ankle fractures affecting the geriatric patient population, focusing on risk factors for fracture and surgical versus nonsurgical management. 30 patientsMethods: with closed displaced bimalleolar ankle fractures presenting to Dr B R Ambedkar medical college casualty from September 2020 to February 2022 who underwent surgery were taken into the study . The maximum studyResults: population belonged to the geriatric age group .At the end of follow-up (64.8%) had excellent clinical result, (35.2%) had good clinical result, and no patient had a poor functional outcome. For the radiological assessment, there were 20 patients (66.6%) with excellent, 7 (23.3%) with good, 3(10.%) with fair, while none with poor resu :Conclusion Treatment bimalleolar ankle is challenging because of limited soft tissue cover, poor bone quality with osteoporosis and less vascularity. There are various treatment options for these fractures starting from closed reduction with casting to open reduction and internal fixation with a plate. The excellent functional results and lack of soft tissue complications suggest that a surgical management with CC screw and plating should be considered as an option in bimalleolar ankle fractures. A balance between anatomical reduction and soft tissue stripping is required to avoid any complications.

Anatomic sphincteroplasty with combined reconstruction of internal and external anal muscles in the anal incontinence surgical treatment

Several groups studying the results of the classic sphincteroplasty show improvement of 75% of patients treated in a short-term follow-up, with a worsening of this data in the long-term follow-up down to an improvement of 50% of the patients. Some other groups published more optimistic results, showing an 80% success rate without any deterioration of the technique over time after introducing a separate repair of the internal and external muscles. We think that the introduction of some modifications in the classic technique, named “Anatomic sphincteroplasty with combined reconstruction of external and internal anal sphincter muscles” may obtain very good clinical and anorectal manometric results both in a short and mid-term follow-up. In addition, increasing the pressive length in the anal canal may contribute to maintain more stable results over time.

A Scientometric Analysis and Visualization Discovery of Enhanced Recovery After Surgery.

BackgroundEnhanced recovery after surgery (ERAS), a new clinical surgical concept, has been applied in many surgical disciplines with good clinical results for the past 20 years. Bibliometric analysis is an effective method to quantitatively evaluate the academic productivity. This report aimed to perform a scientometric analysis of the ERAS research status and research hotspots.MethodsComprehensive scientific mapping analysis of a wide range of literature metadata using the scientometric tools, including the Bibliometrix R Package, Biblioshiny, and CiteSpace. Data were retrieved from the Web of Science Core Collection database of original articles from 2001 to 2020. Specific indicators and maps were analyzed to show the co-authorship, co-institute, co-country, co-citation, and international cooperation. Automatic literature screening, unsupervised cluster filtering, and topic cluster identification methods were used to display the conceptual framework and thematic evolution.ResultsA total of 1,403 research projects drafted by 6,966 authors and published in 413 sources were found. There was an exponential growth in the number of publications on ERAS. There were 709 collaborations between authors from different countries, and the US, China, and the UK had the greatest number of publications. The WORLD JOURNAL OF SURGERY, located in Bradford’s Law 1, had the highest number of published articles (n = 1,276; total citations = 3,193). CiteSpace network analysis revealed 15 highly correlated cluster ERAS studies, and the earliest study was on colonic surgery, and ERAS was recently applied in cardiac surgery. The etiology of ERAS is constantly evolving, with surgery and length of hospital as the main topics. Meta-analyses and perioperative care have tended to decline.ConclusionThis is the first scientometric analysis of ERAS to provide descriptive quantitative indicators. This can provide a better understanding of how the field has evolved over the past 20 years, help identify research trends, and provide insights and research directions for academic researchers, policymakers, and medical practitioners who want to collaborate in these areas in the future.

A New Total Knee Arthroplasty Technique for Valgus Knees that preserves the deep layer of the medial collateral ligament.

The aim of this study was to assess the outcomes and complications, such as tibiofemoral instability and recurrence of valgus deformity, of total knee arthroplasty for valgus knees with a new technique preserving the deep layer of the medial collateral ligament. In this study 33 (4 male and 29 female) patients, and a total of 36 (26 knees with osteoarthritis and 10 with rheumatoid arthritis) knees with a standing femorotibial angle (FTA) of <170° were included. Posterior Stabilized (PS) implants were used in 34 knees, rotating hinged knee implants were used in 2 knees. The procedures were carried out by a single surgeon protecting the deep layer of the medial collateral ligament. The patients' average age at the time of the operation was 67.6 ± 12 years, and the average follow-up period was 9.0 ± 3 years (range, 4-15 years). The Japanese Orthopaedic Association (JOA) knee score, range of motion (ROM) (extension/flexion; measured in degrees), FTA (measured in degrees) and complications were investigated. The Japanese Orthopaedic Association knee score significantly improved from an average of 51 ± 12 points before the operation to 86 ± 9 points after the operation (P <0.001). The extension ROM and flexion ROM improved from, -13 ± 13° to a postoperative average of -2 ± 4°, and 115 ± 25° to a postoperative average of 125 ± 18° respectively (P <0.001). The standing FTA significantly improved from 158 ± 9° to an average of 173 ± 2° after the operation (P <0.001). Thirty-four knees with severe valgus deformity were operated on using pos- terior stabilised implants, while only two knees required constrained implants. During follow-up, no complications, such as tibiofemoral instability, recurrence of valgus deformity, patellar necrosis, deep infection, wound problems, or peroneal nerve paralysis were observed. This study has shown us that after performing TKA while preserving the d-MCL for valgus knee deformity good clinical results were obtained and no complications were observed. Level IV, Therapeutic Study.

Functional and radiologic results of the crimson duvet procedure in rotator cuff treatment: a randomized controlled clinical trial.

Rotator cuff tears are one of the more frequent pathologies of the shoulder. Arthroscopic techniques and biologic augmentation have been developed to improve the rate and quality of healing. The crimson duvet procedure (CDP) theoretically provides mesenchymal stem cells through microfracture treatment of the footprint. The aim of this research was to evaluate the effect of CDP in patients who had undergone arthroscopic surgery for complete rotator cuff repair. A prospective randomized clinical trial was performed in a total of 123 patients, consisting of 59 women and 64 men, with a mean age of 58 years. We included patients with a clinical and radiologic diagnosis of a complete rotator cuff tear. All patients were treated with arthroscopic rotator cuff repair. In group 1, the surface of the footprint was débrided; in group 2, the footprint underwent microfracture. The primary outcome was the nonhealing rate, which was detected by magnetic resonance imaging (MRI) or ultrasonography, and the secondary outcome was the functional result. A Sugaya classification of I to III was considered to indicate healing. For clinical evaluation, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Constant scores were evaluated, along with the range of motion. The functional evaluation was performed preoperatively and at 6 months and 1 year postoperatively. The radiologic (MRI or ultrasonography) evaluation was performed at 6 months. Neither the patients nor the radiologists and physical therapists who performed the postoperative evaluations were informed of the random selection. We observed a healing rate of 85.11% in the control group and 93.7% in the CDP group, which was not significant (P=.19). However, a significant improvement in function was observed in all patients. The ASES score improved from 68.9 (SD 13.8) preoperatively to 92.2 at 6 months and to 96.4 (SD 6.2) at 12 months (P<.05), but no difference was observed between the groups. A similar level of improvement was observed in the Constant score. The arthroscopic repair of complete rotator cuff tears presents good and excellent clinical results in most patients. Nevertheless, nonhealing occurs at a rate that depends mainly on the age of the patient and the size of the tear. The addition of CDP did not improve the functional results or the healing rate.

Моделирование шва сухожилия с его изоляцией для демонстрации первичной регенерации зоны соединения

Introduction Functional recovery of the finger flexor tendon after surgical treatment is a problem due to formation of unavoidable blocking adhesions. For prevention of the adhesions, the mechanical separation of the sliding surfaces of the tendon and the wall of the fibro-osseous canal with a polymer tube was proposed. However, despite good clinical results, it is not possible to morphologically confirm the healing of the suture zone after such an intervention. Objective To present an experimental model and technique of surgical intervention on the calcaneal tendon of laboratory animals for isolation and blocking with a polymeric tube, longitudinally cut, for obtaining and studying the regenerate in the suture site Materials and methods In an experiment under inhalation anesthesia with Isoflurane on both hind paws of 10 laboratory Wistar rats, the tendon suture was simulated with blocking and isolation of the tendon suture (n = 14) and the control operation without isolation (n = 6). The tendons were excised three weeks post-surgery, and the appearance and histological picture of the regenerates in the suture zone were examined. Results The surgery model with isolation of the suture site on the calcaneal tendons of rats reproduces well and adequately simulates the operation on the human hand tendons. The morphology of the obtained regenerates demonstrates the restoration of continuity with the formation of tendon-like tissue at the junction. In the experiment, subtotal isolation did not lead to tendon necrosis, but slowed down the healing of the suture zone. The tube prevented the formation of adhesions and maintained tendon nutrition through the fissure space. Conclusion Modeling of the operation of tendon suture on the rat calcaneal tendon with its isolation provides material for demonstration the primary tendon regeneration in vivo. Regeneration of the suture site during subtotal isolation slows down and occurs due to the cells of the tendon itself.

Synergistic cytostatic effect of bleomycin with cisplatin on Hela cells.

e15002 Background: Bleomycin is a glycopeptide antibiotic with anticancer properties. Clinical data indicate a relatively low efficacy of bleomycin in mono regimen, which is also accompanied by side effects from high doses. That’s why so it is more often used in relatively low doses in combination with other chemotherapy drugs. In particular, in cervical cancer, bleomycin is used in combination with cisplatin in a dose ratio of 0.8:1. Despite good clinical results, it is not known how the two drugs interact in vitro. The aim of this study was to evaluate the effect of combined application of bleomycin and cisplatin on HeLa cells. Methods: HeLa cells were seeded at 3000 cells per well in a 96-well plate (Eppendorf, Germany) and incubated for 24 hours in DMEM medium (Gibco, USA) supplemented with 10% FBS (HyClone, USA) at 37°C in an atmosphere containing 5.0% CO2. After 24 hours, the culture medium was replaced with a medium containing chemotherapy drugs in combination or as standalone agents in a series of two-fold dilutions: 0.03 - 32 µg/mL cisplatin and 0.012 – 12.8 µg/mL bleomycin. After 2 h exposition to studied compounds the medium was replaced and cells were incubated for another 72 hours. At the end of the experiment, the number of living cells was assessed using the MTT test. Viability was determined as the number of living cells in % of the control without the addition of chemotherapy drugs. Results: The combination of cisplatin with bleomycin demonstrated significantly greater efficacy than pure cisplatin in the concentration range from 0.03 µg/ml to 8 µg/ml, and pure bleomycin in the range of 0.012 - 12.8 µg/ml. The difference between the mean viability values for each concentration of pure bleomycin or pure cisplatin and their 0.8:1 mixture was significant at α = 0.05 (df = 14). Observed decrease in the viability of HeLa cells in comparison with pure substances is most pronounced in the range of non-toxic concentrations for both substances in mono regimen, namely 0.03 - 0.5 μg/ml for cisplatin, and at concentrations less than 0.125 μg/ml for bleomycin. Here, the increase in the difference between the dose-response curves grows as the concentration of the studied drugs increases. At cisplatin concentrations of 0.5–32 μg/ml, the difference in HeLa cell viability between pure cisplatin and its combination with bleomycin, on the contrary, decreases linearly with increasing cisplatin concentration, becoming insignificant above 16 μg/ml. Conclusions: The combined use of bleomycin and cisplatin on HeLa culture in a dose ratio of 0.8:1 exhibits synergistic properties that are most pronounced in the concentration ranges of both substances that do not have a cytotoxic effect in mono regimen.

Patient-reported outcome and survival following meniscal allograft transplantation : an international case series.

Meniscal allograft transplantation (MAT) for patients with symptomatic meniscal loss has demonstrated good clinical results and survivorship. Factors that affect both functional outcome and survivorship have been reported in the literature. These are typically single-centre case series with relatively small numbers and conflicting results. Our aim was to describe an international, two-centre case series, and identify factors that affect both functional outcome and survival. We report factors that affect outcome on 526 patients undergoing MAT across two sites (one in the UK and one in Italy). Outcomes of interest were the Knee injury and Osteoarthritis Outcome Score four (KOOS4) at two years and failure rates. We performed multiple regression analysis to examine for factors affecting KOOS, and Cox proportional hazards models for survivorship. Our results indicate that baseline KOOS4 score affects functional outcome at two years, but no other included factors were significantly related to functional outcome. The only factor that affected failure rate was the presence of cartilage lesions down to bone on both the femur and tibia, decreasing the five-year survivorship from 95% (95% confidence interval (CI) 91 to 99) to 84% (95% CI 74 to 94). To our knowledge, this is the largest international cohort reporting on MAT. Our results indicate that factors such as age, BMI, and cartilage lesions down to bone on both the femur and tibia of the affected compartment should not present barriers to offering MAT. Baseline KOOS4 score and the presence of bone-on-bone arthritis can be used to help counsel patients regarding the expected risks and rewards of surgery. Cite this article: Bone Joint J2022;104-B(6):657-662.

Salter pelvic osteotomy for the treatment of Developmental Dysplasia of the Hip: assessment of postoperative results and risk factors.

If non-surgical treatment of Developmental Dysplasia of the Hip (DDH) fails or if DDH is late-detected, surgery is necessary. Salter pelvic osteotomy (SPO) is an effective surgical option for such cases. To study the results after SPO; to evaluate risk factors; to reveal radiological parameters that may correlate with results. Results analysis in 17 patients (22 hips). Risk factors included those that do not depend on the surgeon (patient's age, value of the acetabular index (AI) preoperatively, DDH Tonnis grade) and those that depend on the surgeon (amount of AI correction). To radiological parameters which may correlate with the amount of AI correction we referred distance "d" and the lateral rotation angle. SPO allows performing AI correction in ranges 24.1 ± 6.5°. Excellent and good clinical results were obtained in 95.5% of patients; excellent and good radiological results in 86.4% of patients. Risk factors that do not depend on the surgeon were older patient's age and higher preoperative AI values (p <0.05). The risk factor that depends on the surgeon was the amount of AI correction (p <0.05). The distance "d" was recognized as a radiological parameter that may indicate sufficient AI correction (p <0.05). In older patients with a higher preoperative AI value the results will be predictably worse. The surgeon may influence the result with a greater amount of AI correction (which may also be indicated radiologically by the distance "d" values). IV, therapeutic, case series.

A case of successful conservative therapy of patient with severe heart failure caused by ischemic heart disease: case report

The development of heart failure in any patient causes a lot of concerns in view of the deterioration of quality of life of the latter. A clinical case of a patient with severe heart failure with a low left ventricular ejection fraction is described. The uniqueness of the demonstrated case consisted in the possibility of not only preserving the remaining resources of the heart muscle, but also in a significant restoration of systolic heart function due to adequate conservative therapy. The article presents a clinical case of successful restoration of contractile function of the heart in ischemic cardiomyopathy against the background of adequate conservative therapy. The diagnosis was not accompanied by difficulties. The patient underwent electrocardiography, echocardiography, coronary angiography, laboratory tests. According to the results patient was diagnosed with severe decompensated heart failure with reduced ejection fraction caused by coronary heart disease with NT-proBNP level of 286 ng/L. The results of coronary angiography did not reveal critical stenosis of the coronary arteries, and therefore the patient underwent drug treatment. Guideline-directed medical therapy treatment of chronic heart failure (angiotensin converting enzyme inhibitors, aldosterone antagonist, loop diuretics, beta-blockers, SGLT2 inhibitors) has allowed to achieve a good clinical result. Twelve months after beginning of the treatment left ventricular volume dimensions had changed significantly (LVEDV decreased from 220ml3 to 94ml3; LVESV from 162ml3 to 50 ml3), improvement of left ventricular ejection fraction from 17% to 42% (by Simson). The assessed 6-minute walk test showed functional class III according to the NYHA classification.

Pediatric cranial injuries: the Syrian civil war.

Kilis, Turkey, a city near Aleppo, Afrin and Azez, Syria, where conflicts are intense, is one of the cities that provides initial emergency treatment. The aim in this study was to analyze the clinical and radiological characteristics of and treatment methods and results in pediatric patients admitted to Kilis State Hospital with cranial gunshot wounds obtained during the Syrian war. In this study, 62 pediatric patients treated for cranial gunshot wounds obtained during the civil war in Syria between December 2011 and May 2017 at the Neurosurgery Clinic of Kilis State Hospital on the Turkish side of the Turkey-Syria border were retrospectively analyzed. A total of 62 patients were evaluated. Forty-six (74.2%) patients were male and 16 (25.8%) were female. The mean age of the patients was 11.4 ± 6.3 (range: 1month to 18years) years. The mean Glasgow coma scale (GCS) score was 7.2 ± 3.8. Surgical treatment was performed in 36 patients (58.1%). Six (16.7%) of the surgically treated patients and 15 (57.7%) of the conservatively treated patients died (p < 0.001). While good clinical results (GOS4-5) were obtained in 24 (66.7%) patients who underwent surgical treatment, only 8 (30.8%) patients who underwent conservative treatment had good clinical results (GOS 4-5). The treatment results in patients with a GCS score of between 9 and 15 who were treated with both methods were significantly better (GOS score of 4-5) (p < 0.05) than those in patients with a GCS score of 8 or lower. The treatment results of the patients aged 10-18years were significantly better than those of patients aged 0-9years (GOS 4-5) (p < 0.05). In this study, the GCS score on admission was a significant predictive factor for survival in pediatric patients with cranial gunshot wounds. The outcomes of patients aged 0-9years with severe neurological damage were worse than those in patients aged 10-18years. On the basis of the analyses of the treatment methods and GCS and GOS scores of the patients in our study, we conclude that surgical treatment should be performed immediately in all patients with radiological indications and a GCS score higher than 3. Additionally, we conclude that child soldiers exist in Syria.

Management of glenoid bone loss with impaction and structural bone grafting in reverse shoulder arthroplasty.

Glenoid bone loss is a commonly encountered problem in complex primary and revision shoulder arthroplasty. Addressing glenoid bone loss is critical to avoid complications like early loosening, impingement, notching and instability. A large number of techniques like bone grafting using autograft or allograft, eccentric reaming, augmented base plates, patient-specific instrumentations and custom-made implants are available to tackle bone loss. We prospectively collected the data of all patients with glenoid defects undergoing primary or revision reverse shoulder replacement between 2004 and 2017. This included demographic data, ranges of motion, Constant-Murley score and Subjective Shoulder Value(SSV). A pre-operative CT scan was done as well to plan the surgery and calculate the glenoid version. At each follow-up, the clinical function and shoulder scores were assessed. Additionally, the radiographs were assessed for graft incorporation, evidence of lysis and calculation of glenoid version. Between 2004 and 2017, 37 patients underwent glenoid bone grafting during reverse shoulder arthroplasty. Average age was 72years (range 46-88). Indications for surgery were cuff tear arthropathy (6 patients); revision of failed other prosthesis (23); primary osteoarthritis (4); rheumatoid arthritis (3); and second-stage revision for infection (1). The glenoid defect was contained in 24 patients, and therefore, impaction graft with a combination of bone graft substitute and/or humeral head autograft was performed. In 13 patients the glenoid defect was severe and uncontainable and therefore a graft-implant composite glenoid was implanted using humeral head autograft or allograft. Average follow-up was 3.6years (range 1-10). Mean Constant score improved from 34 before surgery to 63 after surgery. Mean SSV score improved from 0.9/10 to 8.3/10. Active movements improved significantly with forward elevation increasing from 54° to 123°; abduction from 48° to 123°; external rotation from 24° to 38°; internal rotation from 57° to 70°. Radiographs at final follow-up showed no radiolucencies around the glenoid component and no evidence of loosening of the implant. In 2 cases there was a grade I notching. There was 100% survivorship at the last follow-up. Impaction bone grafting along with structural grafting when required is an effective and reproducible way of managing severe glenoid bone loss. This technique gives consistent and good clinical and radiological results.