Low Complication Research Articles

Comparative efficacy and fusion outcomes of unilateral bi-portal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion in treating single-segment degenerative lumbar spondylolisthesis with lumbar spinal stenosis: a two-year retrospective study

BackgroundDegenerative lumbar spondylolisthesis (DLS) with lumbar spinal stenosis (LSS) is a common condition resulting in substantial lower back pain and disability. Surgical intervention is recommended only when conservative treatment fails. This study compared UBE-TLIF and MIS-TLIF regarding clinical outcomes and fusion rates in patients with single-segment DLS with LSS.MethodsA total of 85 patients who underwent either UBE-TLIF (n = 40) or MIS-TLIF (n = 45) were examined retrospectively. Clinical results were evaluated by the Visual Analog Scale (VAS) for pain and the Oswestry Disability Index (ODI) for functional outcomes. Radiographs and CT were utilized to assess radiological outcomes such as disc height (DH), lumbar lordosis (LL), and interbody fusion rates. The two groups were also compared in terms of perioperative data (operation time, blood loss, hospital stay, and fluoroscopy exposure).ResultsBoth surgical techniques showed similar statistically significant improvements in VAS and ODI scores. Fusion rates at 2 years postoperatively were identical, including 95% for the UBE-TLIF group and 97.7% for the MIS-TLIF group. However, compared with MIS-TLIF, the operative time and fluoroscopy exposure were longer for UBE-TLIF, but intraoperative blood loss and length of hospital stay were reduced.ConclusionsUBE-TLIF and MIS-TLIF can successfully treat single-segment DLS in the presence of LSS, achieving similar clinical and radiological outcomes with low complication rates. Although UBE-TLIF has certain advantages regarding perioperative outcomes (less blood loss and shorter hospital stay), MIS-TLIF is associated with shorter operative times and lower fluoroscopy exposure.

Clinical outcomes after emergency transarterial renal embolization: a retrospective study

BackgroundStudies on emergency transarterial embolization (TAE) of renal arterial injuries are rare. The aim of this retrospective study was to evaluate clinical outcomes after emergency transarterial renal embolization.Material and methodsBetween January 1st, 2013 and January 1st, 2024, all consecutive patients treated for renal arterial injuries by TAE in emergency settings were retrospectively reviewed. Demographic, biological and angiographic data were recorded. The inclusion criteria were all patients ≥ 18-years-old treated by emergency TAE for renal vascular injury. Clinical success was defined as the resolution of bleeding signs without the need for repeat TAE, surgery, death related to massive blood loss during this period, without functional impairment (> 50% of parenchyma volume or onset of chronic kidney disease) following TAE.ResultsDuring the inclusion period, 79 procedures were performed. The median age was 60[39–73] years old. On preoperative CT, ≥ 1 pseudoaneurysm was detected in 36(45.6%) patients, and active bleeding in 47(65.8%) patients. The preoperative median haemoglobin rate was 8.9[7.6–11] g/dl, and 37(46.8%) patients required red blood cell transfusions. The main aetiologies of arterial injury were blunt trauma (n = 19) and renal biopsy (n = 17). No severe adverse events were reported. Clinical success was reported in 74(93.7%) of the procedures. Three (3.8%) repeat embolizations were required, and were clinically successful. During the median follow-up of 7[1.5–35.5] months, 9(11.4%) patients died, of which 5(6.3%) occurred within 30 days.ConclusionThe present study reports high clinical success, low complications and low rebleeding rates of emergency renal TAE.

Investigation of Abdominoplasty Without General Anesthesia: A Scoping Review

Introduction: Abdominoplasty is a common aesthetic surgical procedure primarily performed under general anesthesia (GA). However, GA is aerosol-generating and involves extended immobilization associated with systemic complications like venous thromboembolisms (VTEs). There is increasing interest in performing abdominoplasties without GA because of potential lower complication rates and shorter postoperative recovery time. This review sought to summarize all available literature on the safety and outcomes of abdominoplasty performed without GA. Methods: A scoping review was conducted with no date limits in October 2023 encompassing Medline, Embase, Web of Science, and CINAHL. The type of anesthesia was separated into 3 categories: conscious or intravenous (IV) sedation, regional anesthetic blocks (RAB: spinal and epidural), and local anesthesia (direct local infiltration and field blocks). Results: A total of 28 studies were included. Safety data was reported for abdominoplasty alone ( n = 6), with liposuction ( n = 14), or both ( n = 1). The employed anesthesia methods were IV and local ( n = 13), RAB and local ( n = 3), IV and RAB ( n = 2), IV and RAB and local ( n = 2), and IV only ( n = 1). A total of 48 379 patients were identified, with 30 cases of VTEs reported. Two studies reported GA conversion rates between 4.8% and 6.0%. A total of 11 studies assessed abdominoplasty outcomes, highlighting high patient satisfaction and low postoperative pain. The majority of analyzed studies had a “high” or “critical” risk of bias. Conclusion: Our review provides preliminary evidence that performing abdominoplasty without GA is safe and feasible. Additional high-quality studies are necessary to further validate our findings and to develop a standardized approach.

Early results of primary total hip arthroplasty performed in young adults at a regional Saudi-Arabian orthopedics center: a prospective observational study

Background. Younger patients undergoing primary total hip arthroplasty (THA) have different indications and outcomes than elderly patients. Furthermore, studies reporting the results of THA in young patients are scarce in our area. The aim of the study is to report the early experience and clinical results after total hip arthroplasty in patients ≤40 years old from a regional Saudi-Arabian hospital as a representative of the Arab (Middle Eastern) population. Methods. We conducted a prospective observational study over one year by following all patients (≤40 years) who underwent primary THA at a regional Saudi-Arabin orthopedics center. Twenty-five patients (a mean age of 31.60±6.07 years, and 14 (56%) were males) were eligible for final inclusion. The functional assessment was performed according to the Harris Hip Score (HHS), leg length discrepancy (LLD) was evaluated, and complications at any point were reported. Results. The commonest indication was advanced avascular necrosis (28%) followed by post-traumatic osteoarthritis (24%) and rheumatoid arthritis (24%). Cementless fixation was utilized in 20 (80%) THAs, and the bearing surface was either metal- or ceramic-on-polyethylene in 92% of THAs. After a mean follow up of 20.0±4.5 months, HHS improved from a pre-operative mean of 29.20±5.29 to 85.48±7.18 (p = 0.0001). Excellent and good results were reported in 84%. All working patients (52%) returned to their jobs after THAs. The leg length discrepancy improved significantly from a pre-operative mean of 2.12±1.01 cm to the last follow up mean of 0.72±0.4 cm, p = 0.0001. Two (8%) patients had superficial wound infections at the time of suture removal, which were treated successfully by daily dressing and antibiotics. None required revision. Conclusions. Primary total hip arthroplasty is the option for managing end-stage hip disease, even in younger patients when hip preservation surgeries are invalid. Our results showed improved functional outcomes and a return to pre-disease daily activities in most patients, with considerably lower complication incidence.

Minimally invasive balloon-assisted sinus floor elevation vs. conventional transcrestal procedure in terms of new bone formation in a split-mouth Goettingen minipig model

PurposeCurrently, maxillary sinus floor (SF) elevation is based on off-the-shelf allogeneic, xenogeneic or synthetic bone augmentation materials (BAM) that are implanted via an open lateral sinus wall approach (OSFE). However, this invasive method is associated with postoperative complications caused by an inadequate blood supply of the alveolar ridge. Balloon-assisted procedures are minimal invasive alternatives with lower complication rates. The aim was to evaluate local new bone (NB) formation in the SF following the application of a particulate BAM (Easy graft) via two different SF elevation techniques in a split mouth mini-pig sinus augmentation model.Material and methodsSeven adult Goettingen minipigs were used for evaluation of a biphasic ceramic (PLGA/ß-TCP) BAM in the elevated SF region. Treatments were randomized to the contralateral sinus sites and included two procedures: OSFE (control group) versus minimally invasive SF elevation by a balloon-lift-control system (BLC) (treatment group). The animals were euthanized after 28 and 56 days for analysis of new bone (NB) formation.ResultsThe biphasic synthetic BAM implanted via BLC increased more NB formation (5.2 ± 1.9 mm and 4.9 ± 1.6 mm vs. 2.6 ± 0.5 mm) and osseointegration of the particles (18.0 ± 6.0% and 25.1 ± 18.2% vs. 10.1 ± 8.0%, p < 0.05) compared to the control.ConclusionsImplantation of a biphasic synthetic BAM enhanced NB formation in the mini-pig maxillary sinus at both time points and in both groups, although BLC resulted in a slightly better total NB formation compared to the control.Graphical abstract

Outcomes of Simultaneous Correction of Adult Hallux Valgus and Flexible Pes Planus Deformities.

There is a high correlation between hallux valgus and pes planus deformity. We sought to evaluate the outcomes of simultaneous Scarf osteotomy and extraosseous talotarsal stabilization (EOTTS) for correcting adult hallux valgus with flexible pes planus deformity. This retrospective study enrolled patients who had hallux valgus deformity with flexible pes planus and underwent combined Scarf osteotomy and EOTTS from January 2018 to October 2021. The hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch, and lateral talocalcaneal angles were assessed preoperatively and at 1-year follow-up. Clinical outcomes were evaluated using the visual analog scale (VAS) score for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, and the Maryland foot score (MFS). Complications were recorded. This study included 25 patients, 19 women and 6 men, with a mean age of 44.3 years. The mean follow-up period was 14.6 months. The mean HVA, IMA, Meary's angle, calcaneal pitch, and lateral talocalcaneal angles improved significantly at 1-year follow-up (P<.001). The mean VAS score decreased from 5.8 to 1.0, whereas the mean AOFAS forefoot score and MFS increased from 52.3 to 88.9 and 61.2 to 89.3, respectively, at 1-year follow-up (P<.001). Two patients had arthroereisis implant removal as a consequence of sinus tarsi pain. No other complications were seen during the follow-up. Management of hallux valgus with flexible pes planus deformity with combined Scarf osteotomy and EOTTS can achieve satisfactory clinical and radiologic results with low complication and recurrence rates. [Orthopedics. 202x;4x(x):xx-xx.].

Posterior cricoid plate drill enlargement in idiopathic subglottic stenosis.

Idiopathic subglottic stenosis(ISS) is an airway stricture between larynx and trachea, within 1 cm from the vocal cords. Resection-reconstruction presents technical issues because of the need to resect the anterior portion of the cricoid cartilage, but not the posterior plate beyond which the recurrent laryngeal nerves access the vocal cords. The main surgical challenge consists of the minute airway caliber short below the cords, ensuing after the resection. We propose drill posterior cricoid plate molding to obtain antero-posterior and lateral amplification of the laryngo-tracheal anastomosis. This is a retrospective study of patients who underwent laryngo-tracheal resection with drill enlargement between January 2023 and June 2024. Laryngo-tracheal resection was performed according to Pearson. At this point airway caliber is gauged by endotracheal tubes of increasing size. To enlarge the air space, the inner surface of the posterior plate was molded by drill. Breathing, complications, voice and swallowing function were recorded. Our study includes 23 consecutive patients with ISS. No mortality described. Fifteen patients(65.2%) described voice alteration and 7(30.4%) experienced transient swallowing impairment. The mean operative time was 94.56(±28.72) min. All patients breathed well at discharge. Overall early success rate was excellent (no sequelae) in 7(30.4%) patients, and good(grade A: voice/breathing changes not influencing the quality of life; grade B: abnormal voice and shortness of breath, not hindering normal activities) in 15(65.2%). At the mean follow-up of 10.5 ± 5.5 months definitive success was achieved. This is the first study describing this technique. The results of our early experience with drill molding of the posterior cricoid plate are promising. It is an innovative, simple, safe, and effective method for subglottic airway enlargement in ISS, resulting in low post-operative complications, and in good to excellent results. Prot. n. Prot. n. C. 139/December 2023.

Low Complication Rates in Olecranon Fracture Fixation With Dual Plating.

Most olecranon fractures are intra-articular, affecting the extensor mechanism of the elbow, and are treated surgically with dorsal plate fixation or tension band. Due to shortcomings of dorsal plates related to prominence, insufficient fixation of sagittal fracture lines, and difficulty matching proximal ulna dorsal angulation (PUDA), dual medial and lateral plating (DP) has been developed. We hypothesized that olecranon fractures treated with DP would have low complication rates and low incidence of hardware removal compared with those treated with traditional methods of fixation. The database of a single institution was reviewed for the period January 2017 to April 2023 for adults with olecranon fractures receiving DP fixation. Open fractures, fracture dislocations, previous elbow injuries, and pathologic fractures were excluded. Demographics, pre- and postoperative imaging, reoperations, and range of motion were collected. PUDA and varus angulation measurements, intra-articular step off, and fracture distraction were recorded. A total of 42 fractures in 41 patients were reviewed. Mean follow-up was 8.7 months (range, 3-36 months). One patient reported symptomatic hardware at 6 weeks that had resolved by 3 months, and 1 reported persistent symptomatic hardware not bothersome enough to warrant removal. Five patients (11.9%) had at least 1 postoperative complication. The hardware removal rate was 2.4%. DP for olecranon fractures represents a valuable strategy in fracture treatment. We report a low hardware removal rate of 2.4%, with removal being done for infection, not symptomatic hardware. DP provides a reliable method of fixation, helps re-create native anatomy, and has a low complication rate compared with standard dorsal plating. [Orthopedics. 202x;4x(x):xx-xx.].

Enhancing Pediatric Forearm Fracture Management: The Role of Extension Casting in Reducing Repeat Interventions

Background: Fractures of the forearm are common in the pediatric population, often requiring careful management to ensure optimal outcomes and minimize long-term complications. Among the various treatment modalities available, extension casting has emerged as a promising approach in pediatric forearm fracture management. Objective: The aim was to evaluate the effectiveness of extension casting in reducing the need for repeat interventions in pediatric forearm fractures. Methods: This study was a prospective cohort study conducted at the Department of Orthopaedics &amp; Traumatology of Khwaja Yunus Ali Medical College &amp; Hospital, Enayetpur, Sirajganj, from July 2020 to July 2023. A total of 60 pediatric patients, aged 5-12 years, with acute forearm fractures were enrolled. Different statistical methods were adopted in this study. All analyses were performed using SPSS version 25.0. Results: The study of 60 pediatric patients with forearm fractures showed a mean age of 8.2 years, with 60% males. Most fractures were in the middle third of the forearm (60%). At 12 weeks, 87% maintained satisfactory reduction. Only 10% required repeat interventions. PODCI scores indicated excellent functional recovery, low residual pain, and high satisfaction. Minor complications included skin irritation (6.7%) and transient nerve palsy (3.3%), with no long-term complications. Conclusion: The results of this study affirm the effectiveness and safety of extension casting in managing pediatric forearm fractures. This method not only ensures better maintenance of fracture reduction and reduces the need for repeat interventions but also yields excellent functional outcomes and low complication rates. J Rang Med Col. September 2024; Vol. 9, No. 2: 50-55

A Comparative Study of Planned and Unplanned Manual Small Incision Cataract Surgery (MSICS) Outcomes at Nan Hospital, Thailand: A Retrospective Study

Objective: To compare the visual outcomes and complications of planned and unplanned manual small incision cataract surgery (MSICS) using Ruit technique in cataract patients. Materials and Methods: The medical records of 3,107 eyes for 2,642 patients with cataracts who underwent MSICS using the Ruit technique at Nan Hospital between January 2016 and April 2023 were retrospectively reviewed. MSICS used a temporal scleral tunnel incision. All 3,107 surgeries were performed by a single surgeon. Out of these 908 eyes of 719 patients, 411 eyes missed the six-week follow-up, the data were incomplete on 195 eyes, 58 eyes underwent combined ocular procedures, and 244 eyes had preoperative vision impairing pathology or previous ocular surgeries. Medical records of 2,199 eyes from 1,923 patients were analyzed, including data on preoperative and postoperative uncorrected visual acuity (UCVA), operative time, intra- and postoperative complications, and astigmatism at the second and sixth weeks after surgery. Results: MSICS using Ruit technique was performed on 2,199 eyes of 1,923 patients. Both groups achieved excellent surgical outcomes with low complication. The postoperative UCVA at the sixth-week follow-up was 20/70 or better in 96.2% (1,467 out of 1,526 patients) in the planned group and 94.7% (637 out of 673 patients) in the unplanned group. At the sixth week after treatment, the median postoperative astigmatism of both groups were –1.0 (IQR –1.5 to –0.5) D. Hyphema was the most frequent intraoperative complication found in both groups, equating to 5.9% (90 out of 1,526 patients) in the planned group and 8.2% (55 out of 673 patients) in the unplanned group. There was no significant difference in the visual results and complication rates between the groups (p&lt;0.05). Conclusion: The present study demonstrates that cataract surgery in the unplanned group was safe, and the outcomes in terms of visual results and complications were comparable to those of the planned group. The findings revealed that favorable visual outcomes could be achieved with Ruit technique MSICS. Keywords: Ruit technique; Manual small incision cataract surgery

Three-unit posterior monolithic fixed dental prostheses made from high-translucent shade-graded zirconia: 3-Year results from a prospective clinical pilot study

ObjectivesTo assess the clinical performance of tooth-supported 3-unit fixed dental prostheses (FDPs) made from shade-graded monolithic 5Y-PSZ (partly stabilized zirconia) zirconia in terms of survival rate and the quality of restorations based on modified FDI criteria over three-years.Materials and methodsHigh-translucent shade-graded monolithic zirconia (Lava Esthetic, Solventum Dental Solutions) was used to manufacture maxillary or mandibular three-unit FDPs in the posterior region (N = 22) employing subtractive milling system (Amann Girrbach). All FDPs were bonded with a universal resin cement (Rely X Universal, Solventum Dental Solutions) and evaluated 4 weeks after cementation (baseline) and after 1, 2, and 3 years. The primary objective was to assess the survival and complication rates of the restorations. Furthermore, the quality of the restorations was evaluated based on selected and modified FDI (World Dental Federation) criteria, which encompass functional, aesthetic, and biological parameters. FDI criteria were analyzed using the Fisher-Freeman-Halton exact test.ResultsTwenty-one patients were examined at 1 year, 2 years, and 3 years. The survival rate was 100%. No mechanical complications were observed. A total of 3 biological complications occurred. These were successfully managed without any residual functional impairment. All FDI criteria were found to be clinically acceptable or better.ConclusionsMonolithic shade-graded zirconia FDPs demonstrated 100% survival at 3 years with a low complication rate.Clinical relevanceFixed 3-unit FDPs made of high-translucent monolithic zirconia might be a viable treatment option in the posterior region, preventing the chipping phenomenon and providing favorable aesthetics while allowing for an efficient digital workflow.

Exploring the efficacy of integrative medicine for chronic conditions: The role of combining allopathy, ayurveda, homeopathy, naturopathy, diet and lifestyle

Chronic diseases are significant and increasing causes of illness and disability throughout the world with significant targeted implications for individual quality of life as well as health systems. Even though these medicines have been proven to be very effective in the so-called ‘acute ‘symptomatic relief ‘of ailments, the conventional biomedicine diagnosis and treatment regimens, particularly the drugs and medicines do not effectively address the chronic diseases that are lifestyle diseases with psychological connotations like cardiovascular diseases, diabetes mellitus or arthritis, etc. Thus, a treatment or therapy plan based on a patient’s constitution and lifestyle might be the solution to improved compliance as well as satisfaction with the integrative approach. However, this is a model that has some concerns of confusion with the pluralism of the treatment approach; thus, it may pose a threat to the modality and standardization while handled by specialized players. However, walking around various therapeutic modalities could initially amount to higher costs and although the costs could be higher, long-term implications such as lowered disease complications and hospitalizations could lead to more cost savings.

3-year Outcomes of Rotating Suture with Root Z-epicanthoplasty for Lower Lid Epiblepharon

Purpose: To report the clinical outcomes of Root Z-epicanthoplasty combined with lower eyelid rotation suturing in patients with lower eyelid epiblepharon, focusing on a 3-year follow-up.Methods: Patients who underwent Root Z-epicanthoplasty combined with lower eyelid rotation suturing from March 2012 to February 2020 were included. Patients aged &lt; 15 years, and who had a minimum 3-year follow-up, were included. We assessed changes in best corrected visual acuity (BCVA), cycloplegic refraction, astigmatism, and surgical outcomes. To evaluate the influence of preoperative amblyopia, patients were divided into subgroups based on amblyopic status; surgical outcomes were compared between these groups. In addition, subgroups were divided based on age at operation and astigmatism were compared between subgroups.Results: A total of 55 patients (109 eyes) exhibited successful correction of lower eyelid epiblepharon without recurrence; one case experienced a delayed episode of lower palpebral conjunctival hemorrhage. Significant changes were observed of BCVA improvement, myopic shift of cycloplegic refraction, and astigmatism reduction three years post-surgery (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; = 0.024). In the group without preoperative amblyopia (86 eyes), significant changes were noted in BCVA, cycloplegic refraction, and astigmatism (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; = 0.025). In patients with preoperative amblyopia (23 eyes), significant improvements were observed in BCVA and myopic shift in cycloplegic refraction (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; = 0.003), whereas astigmatism showed no significant change (&lt;i&gt;p&lt;/i&gt; = 0.431). There is significant reduction of astigmatism in under 6-year-old group (&lt;i&gt;p&lt;/i&gt; = 0.011) and no significant reduction of astigmatism in over 6-year-old group (&lt;i&gt;p&lt;/i&gt; = 0.589).Conclusions: Root Z-epicanthoplasty with lower eyelid rotation suturing demonstrated a low complication rate and no recurrence over 3-year follow-up, confirming its effectiveness in correcting lower eyelid epiblepharon. The procedure also positively influenced visual development and reduction of astigmatism in pediatric patients.

Reconstruction of the Anterior Buccal Floor by a Nasolabial Flap: Report of a Case and Literature Review

Oral floor defects pose a significant challenge in reconstruction. The primary goal of reconstruction is to preserve tongue mobility, which allows for restoration of chewing, swallowing, and phonation. Current literature suggests that a nasolabial flap is a reliable treatment option for the reconstruction of this type of defect, with a low complication rate and excellent functional and aesthetic results. We present a patient who underwent resection of a gingivomandibular tumor. Due to his age, and the size of the defect, reconstruction was performed with a nasolabial flap. There were no postoperative complications. The purpose of this presentation is to demonstrate the use of the nasolabial flap for reconstruction of the floor of the mouth and to determine its advantages, disadvantages and interest compared to other surgical and microsurgical techniques.

Role of Minimally Invasive Reoperation for Postoperatively Diagnosed T2 Gallbladder Cancer: Multicenter Retrospective Cohort Study.

Although T2 gallbladder cancer (GBC) incidentally diagnosed after cholecystectomy requires additional resection, the surgical approaches are technically difficult due to inflammatory adhesion or fibrosis around the hepatoduodenal ligament and gallbladder bed. In this study, we sought to compare the surgical and oncologic outcomes of open and minimally invasive reoperation for postoperatively diagnosed T2 GBC. Patients who underwent open (n = 110) and laparoscopic (n = 38) reoperation for T2 GBC between November 2004 and October 2022 at five tertiary referral centers were included in this multicenter retrospective cohort study. The short- and long-term outcomes were compared between the two groups. There were no differences in clinicopathological characteristics between the open and laparoscopic groups. Liver resection was more frequent in the open group (101 [91.8%] vs. 21 [55.3%], P < 0.001). Compared with open surgery, laparoscopic reoperation was associated with shorter postoperative hospital stay (9.0 [8.0-10.0] vs. 6.0 [3.8-8.3] days, P < 0.001) and a lower postoperative complication rate (24 [21.8%] vs. 1 [2.6%], P = 0.013). Among patients who underwent liver resection, the postoperative hospital stay was shorter in the laparoscopic group (9.0 [8.0-10.0] vs. 6.0 [4.0-9.0] days, P = 0.004). The 5-year disease-free survival (66.7% vs. 76.1%, P = 0.749) and overall survival (75.2% vs. 73.7%, P = 0.789) rates were not significantly different between the two groups. The results indicate that laparoscopic reoperation for postoperatively diagnosed T2 GBC has favorable postoperative outcomes and similar oncologic safety compared with open surgery.

Catheter-directed therapy with the FlowTriever system for intermediate-high and high-risk pulmonary embolism: asingle-centre experience.

Pulmonary embolism is an important cause of preventable mortality. Treatment strategies depend on risk stratification. High-risk patients, and some intermediate-high-risk patients, require urgent reperfusion therapy. Systemic thrombolysis (ST) is the effective first-choice treatment in these patients; however, the high risk of bleeding complications is amajor drawback. In this single-centre retrospective cohort study, we report our experience with the FlowTriever thrombosuction system as an alternative or adjunct to ST in intermediate-high and high-risk pulmonary embolism. Demographic and clinical data of all patients treated with the FlowTriever system from December 2021 until March 2024 were retrieved from the electronic medical records. Primary outcomes were technical success rate, 30-day all-cause mortality and major bleeding. Twenty-one patients were treated with the FlowTriever system, 14 of whom were considered high risk. The technical success rate was 100%. Thirty-day all-cause mortality was 29% and major bleeding was recorded in 5patients (24%), of which one bleeding event was related to the FlowTriever procedure. Asignificant reduction was seen in mean pulmonary arterial pressure and right ventricular end-diastolic dimension. In intermediate-high and high-risk pulmonary embolism patients with ST treatment failure or acontraindication for ST, the FlowTriever thrombosuction system seems to be aminimally invasive alternative treatment modality with low complication rates.

Comparison of suction technique and non-suction technique in retrograde intrarenal stone surgery: a systematic review and meta-analysis.

To evaluate the clinical efficacy of retrograde intrarenal stone surgery (RIRS) using the vacuum suction technique for the treatment of upper urinary calculi. A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Sino Med, CNKI, WANFANG DATA, and Cochrane. We included studies comparing vacuum suction RIRS with non-vacuum RIRS. Following the PRISMA guidelines, we performed a meta-analysis of the selected studies. Inclusion criteria were randomized controlled trials (RCTs), case-control studies, and retrospective studies evaluating the efficacy of these techniques. Key outcomes analyzed included operative time, hospitalization duration, stone-free rates, and complication rates. Statistical analyses were conducted using mean differences (MD) for continuous variables and odds ratios (OR) for dichotomous outcomes, with corresponding 95% confidence intervals (CI). Sixteen studies (6 RCTs, 1 case-control study, and 9 retrospective studies) involving a total of 2029 patients were included. Meta-analysis revealed that the vacuum suction technique significantly reduced operative time (MD = -14.45min, 95% CI [-18.45; -10.44], P < 0.00001) and hospital stay (MD = -0.54days, 95% CI [-0.80; -0.28], P < 0.00001). In addition, patients in the vacuum suction group had a higher stone-free rate (OR = 3.57, 95% CI [2.57; 4.95], P < 0.00001) and lower complication rates, particularly in reducing postoperative fever. The application of the vacuum suction technique in RIRS significantly improves clinical outcomes by reducing operative time and hospitalization duration, enhancing stone-free rates, and lowering postoperative complication rates. This technique demonstrates a clear clinical advantage over non-vacuum RIRS and should be considered a preferred option for the management of upper urinary tract stones.

Alveolar Ridge Augmentation using Customized Zirconia Membranes: A Systematic Review

Background Since the inception of intraosseous implants, the significance of alveolar bone volume has become crucial in formulating treatment plans for dental implants. Various barrier membranes have been extensively employed in alveolar ridge reconstruction, highlighting their efficacy. Recent advancements include the fabrication of customized barrier membranes using multiple materials, with titanium and zirconia being prominent choices. The objective of this study was to conduct a comprehensive review of all clinical studies, case reports, and case series that utilized customized zirconia membranes for alveolar ridge augmentation. Methods An electronic literature search was performed to find relevant clinical studies, case reports, and case series published in English up to August 2024. The following keywords used in the search were customized zirconia membrane, alveolar ridge augmentation, Guided bone regeneration, zirconia sheet, ceramic sheet, and Personalized membrane. The quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal checklist specific to each type of study. Results The electronic search initially yielded 539 articles. Following deduplication, 263 unique articles remained. Subsequent manual screening of titles and abstracts led to the exclusion of 250 articles, resulting in 13 remaining articles. After conducting a thorough full-text assessment of these 13 articles to verify adherence to the inclusion/exclusion criteria, 6 articles were further excluded, leaving a total of 7 articles included in this review. Conclusion While all studies included in this review were case series or case reports, customized zirconia membranes have demonstrated effectiveness in the literature for alveolar ridge augmentation, facilitating the placement of dental implants in all cases with relatively low complication rates, particularly membrane exposure. There is currently no literature evidence supporting the superiority of zirconia over other materials used in customized fabrication, nor is there evidence of superior design or preferred bone grafting under these membranes.

Effectiveness of balloon angioplasty under intravascular ultrasound guidance in calcified below-the-knee tibial arteries.

This study aimed to assess the optimal balloon diameter for intravascular ultrasound (IVUS)-guided balloon angioplasty in calcified below-the-knee (BTK) tibial artery lesions. Between February 2024 and April 2024, a retrospective review was conducted on 17 patients with Rutherford category 4-6 severely calcified tibial arteries with >70% stenosis, treated with IVUS-guided balloon angioplasty. Sequentially, 3 mm and then 3.5 mm diameter balloons were inflated. The minimum lumen diameter and area were measured before and after the procedure in the proximal, mid, and distal segments of the tibial arteries. One- and three-month follow-ups were conducted using Doppler ultrasound. Significant increases in lumen diameter (P < 0.001 for all) and lumen area (P < 0.001, P = 0.003, P = 0.002, respectively) were observed in the proximal, mid, and distal segments of the BTK arteries following IVUS-guided 3.5 mm balloon angioplasty. Ultra-low iodinated contrast media was used [median 2 mL (range, 1-4 mL)]. Lumen area increase ratios were similar among the proximal, mid, and distal segments (P = 0.905). No target vessel revascularization, major amputation, or mortality was observed during follow-up. Wound healing was seen in 62.5% of the cases with foot ulcers. In the treatment of calcified BTK tibial arteries, a gradual balloon diameter increase up to 3.5 mm in IVUS-guided balloon angioplasty is safe and effective. Gradual balloon diameter increase up to 3.5 mm under IVUS guidance in calcified BTK lesions demonstrates significant potential. It enables ultra-low contrast usage, provides low complication rates, and achieves high patency and limb salvage, along with satisfactory wound healing in the short term.

Percutaneous versus surgical catheter insertion for peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials.

Peritoneal dialysis (PD) is used as a kidney replacement therapy for patients with kidney failure. Institutional practices vary considerably, and the optimal technique for insertion of PD catheters is unknown. This study compared the efficacy and safety of surgical versus percutaneous approaches to PD catheter insertion for patients with end-stage kidney disease. Electronic databases (MEDLINE, Embase, CENTRAL) were systematically searched and analysed for relevant randomized controlled trials (RCTs). Eligible RCTs for inclusion were those that compared surgical versus percutaneous approaches to catheter insertion for patients undergoing PD dialysis. Outcomes of interest were patient- and catheter-related complications. In this study risk of bias was assessed using the Cochrane Risk of Bias Tool for RCTs. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment and Evaluation (GRADE) approach. Four studies (397 participants) were included. With regards to surgical approaches, only one study evaluated laparoscopic insertion; all other studies reported on open surgical techniques. Percutaneous insertion techniques varied significantly between the studies. No difference in patient mortality was found (RR = 0.82, 95% CI = 0.43-1.57, I2 = 0%). Percutaneous techniques were associated with lower rates of early peritonitis (RR = 0.34, 95% CI = 0.12-0.91, I2 = 0%) and long-term catheter failure (RR = 0.69, 95% CI = 0.47-1.00, I2 = 0%) than surgical approaches. Percutaneous catheter insertion was also associated with reduced late peri-catheter leak rates (RR = 0.35, 95% CI = 0.12-0.98, I2 = 0%) and peri-procedural complications (RR = 0.25, 95% CI = 0.07-0.90, I2 = 0%). The overall risk of bias was moderate, and certainty of evidence was low or very low. Whilst percutaneous PD insertion techniques may have lower early and late complications compared to surgical technique, there was a lack of high-quality evidence comparing outcomes between contemporary percutaneous and surgical PD catheter insertion techniques. Future RCTs are required to compare the safety and efficacy of modern percutaneous with laparoscopic techniques.