Moderate Defects Research Articles

“Flap-to-defect” concept for closure of circular skin defects: the ice cream cone flap

While sliding-type skin flaps such as advancement and rotation flaps are useful for closing circular skin defects that are too large to close primarily, these flaps are associated with some technical difficulties that must be overcome. In this study, we aimed to present our clinical experience using an alternative curvilinear advancement-transposition flap designed based upon a “flap-to-defect” concept. A retrospective review was conducted of patient charts and operative photographs of all “ice cream cone flaps” performed at the Department of Plastic and Reconstructive Surgery between May 2014 and November 2018. This method, for the repair of circular-shaped wounds, is intended to allow appropriate distribution of closure tension without necessitating changing the shape of the defect. Patient age, gender, defect size and region, postoperative complications, and esthetic/functional satisfaction were evaluated. The technique, based on the planning of a curvilinear advancement flap that mirrors the defect, was used for reconstruction of circular skin defects that involved various parts of the body. Information from 30 patients with defects ranging from 100 × 70 to 20 × 20 mm with a mean diameter of 30.3 × 20.8 mm were reviewed for the study. All flaps survived without wound infection, hematoma, or flap necrosis complications. During the follow-up period, acceptable esthetic results were achieved. This technique is a good alternative for the closure of small to moderate circular skin defects where adequate skin laxity is present. Level of evidence: Level IV, therapeutic study.

Bone cement with screw augmentation technique for the management of moderate tibial bone defects in primary knee arthroplasty patients with high body mass index.

Objectives This study aims to investigate whether variables such as body mass index (BMI), size of the cement with screw augmentation area (CSA), distance between the base of tibial plate and the deepest point of the defect area (DPDA) may cause any mechanical problems leading to deterioration in tibiofemoral alignment or impact clinical outcomes when the surgeon utilizes bone cement with screw augmentation (BCSA) technique in the treatment of moderate non-contained tibial bone defects in total knee arthroplasty (TKA).Patients and methods This cross-sectional study, conducted between March 2018 and March 2019, included 37 knees of 28 patients (4 males, 24 females; mean age 71.3±8.9; range, 55 to 86 years) with moderate tibial bone defects requiring treatment with BCSA during primary TKA. Patients with BMI >30 were scored with Hospital for Special Surgery (HSS) score for clinical outcomes; besides, CSA, DPDA, and tibiofemoral alignment were calculated on plain X-rays.Results Mean BMI was 34.1±5.7 (range, 24.9 to 45.9). Patients had a mean follow-up period of 44±13.9 (range, 28 to 75) months. Mean postoperative CSA was 98.2±35.3 (range, 42 to 180) mm2 and DPDA was 7.4±2.6 (range, 3.5 to 12.9) mm. Mean HSS score at last follow-up was 88.0±7.5 (range, 71 to 97).Conclusion Bone cement with screw augmentation technique was associated with satisfactory clinical outcomes and tibiofemoral alignment was not significantly deviated in patients with high BMI. We determined that neither the depth of DPDA nor the size of CSA had any correlation with clinical outcomes.

Selective approach to preoperative echocardiography in esophageal atresia.

Preoperative echocardiography is used routinely in neonates with esophageal atresia to identify patients in whom congenital cardiac disease will impact upon anesthetic and surgical decision-making. We aimed to determine the suitability of selective preoperative echocardiography. We performed a single-center retrospective review of neonates with esophageal atresia over 6 years (2010-2015) at our tertiary pediatric institution. Data included preoperative clinical examination, chest x-ray, and echocardiography. Endpoints were cardiovascular, respiratory, radiological, and echocardiography findings. Selective strategies were assessed using sensitivity, specificity, positive predictive value, and negative predictive value. We identified 115 neonates with esophageal atresia. All underwent preoperative echocardiography. Cardiac defects were identified in 49/115 (43%) (major 9/115, moderate 4/115). Sensitivity, specificity, positive predictive value, and negative predictive value of abnormal clinical and radiologic assessment for major and moderate cardiac defects were 92%, 25%, 13%, 96%; for clinical examination alone were 92%, 25%, 14%, 96%; for absence of murmur, cyanosis, and abnormal respiratory examination were 92%, 28%, 13%, 97%. Selective strategies reduce echocardiograms performed by 22%. Selective strategies allow for identification of neonates with esophageal atresia who may have deferral of echocardiogram unill after surgery. Selection may improve timeliness of care and resource utilization, without compromising patient safety.

Focal cartilage defects of the lateral compartment do influence the outcome after high tibial valgus osteotomy.

Introduction: High tibial medial open-wedge valgus osteotomy (HTO) is a well-established procedure for unicompartimental medial osteoarthritis of the young and active patient. However, the influence of cartilage defects of the lateral compartment on the total outcome remains obscure. Methods: From 2005 to 2012, a total of 63 patients underwent HTO for medial osteoarthritis of the knee at a single university orthopaedic center. Baseline data as well as intraoperative findings, including the grade and location of cartilage lesions, were evaluated retrospectively. Two groups were formed regarding the integrity of the lateral tibiofemoral compartment as measured by the Outerbridge score (group A: no lateral cartilage defects, group B: mild to moderate lateral cartilage defects). Functional outcome was assessed using the Knee and Osteoarthritis Outcome Score (KOOS), including its five subscores. Results: Comparing pre- and postoperative data, we identified an overall benefit of the HTO procedure as measured by the KOOS. Group A (no lateral cartilage defects) showed an increase in all five KOOS subscores (p = 0.00–0.01), whereas for group B (mild to moderate lateral cartilage defects), only two KOOS subscores revealed a significant increase (p = 0.03–0.04). There was also a statistically significant difference in the total KOOS score with higher values for group A at the postoperative visit. Cartilage defects with a higher Outerbridge score were associated with lower postoperative KOOS subscores. Discussion: Mild to moderate cartilage defects of the lateral compartment humble the total outcome after HTO procedure. Thus, indication for HTO should be made very carefully if any degree of lateral cartilage degeneration is present.

Disruption of the integrin-linked kinase (ILK) pseudokinase domain affects kidney development in mice

Disruption of the integrin-linked kinase (ILK) pseudokinase domain affects kidney development in mice

Effect of Exercise-Based Cardiac Rehabilitation on Cardiorespiratory Fitness in Adults with Congenital Heart Disease

<b>Background:</b> The purpose of this study was to investigate whether patients with adult congenital heart disease (ACHD) benefit from exercise-based cardiac rehabilitation (CR) short- and long-term with regard to improvement of cardiorespiratory fitness. <b>Methods:</b> Cardiopulmonary exercise tests (CPET) completed by ACHD patients between January 2000 and October 2019 were analysed retrospectively. Linear mixed models were performed for peak oxygen consumption (VO₂) with patients as random effect and age, sex, disease classification, preceding surgery (≤3 months) and preceding CR (≤4 weeks for short term and >4 weeks for long term) as fixed effects. <b>Results:</b> 1056 CPETs of 311 ACHD patients with simple (7), moderate (188) or great (116) complexity heart defects were analysed. The 59 patients who completed a CR (median age 27 yrs, 38% females) increased peak VO₂ from before to after CR by a median of 2.7 (IQR –0.6 to 5.5) ml/kg/min. However, in the multivariate mixed model, peak VO₂ was non-significantly increased short-term after CR (β 0.8, 95%CI –0.7 to 2.4), not maintained long-term after CR (β 0.0, 95%CI –1.7 to 1.6) but significantly reduced after surgery (β –5.1, 95%CI –7.1 to –3.1). The 20 CR patients after surgery increased their peak VO₂ by 6.2 (IQR 3.6–9.5) ml/kg/min, while the 39 CR patients without preceding surgery increased it by 0.9 (IQR –1.5 to 3.1) ml/kg/min. <b>Conclusions:</b> The increase in peak VO₂ with CR was mainly due to recovery from surgical intervention. The small independent benefit from CR was not maintained long-term, highlighting the potential to improve current CR concepts in ACHD populations.

Cost-effective hard–soft carbon composite anodes with promising potassium ions storage performance

Potassium-ion batteries (KIBs) are promising candidates as alternatives to lithium-ion batteries (LIBs) for large-scale energy storage due to the abundant potassium reserves and low cost. However, many well-established anode materials in LIBs are rarely suitable for KIBs. Herein, amorphous carbons including hard carbon, soft carbon and hard–soft carbon composites as KIBs anodes were systematically investigated. The synergy between hard carbon and soft carbon results in structure of relatively large interlayer distance, moderate defects and ordered carbon clusters, leading to excellent electrochemical performance. The hard–soft carbon composite with only 20 wt% hard carbon exhibits high reversible capacity of 376.8 mA h g−1 with a remarkable initial coulombic efficiency (ICE) of 71.04%, an excellent rate capability and a stable cycling performance for KIBs. In addition, full cells assembled with the obtained hard–soft composite as anode and Potassium Prussian blue (KPB) as cathode also exhibit an initial discharge capacity of 200.3 mA h g−1 at 100 mA g−1 and stable cycling performance (146.1 mA h g−1 after 100 cycles at a current density of 100 mA g−1). Owing to the great potential for practical applications, this work may appeal the development of cost-effective and sustainable carbonaceous materials for KIBs.

Altered white matter microstructure is related to cognition in adults with congenital heart disease.

Adults with congenital heart disease are at risk for persisting executive function deficits, which are known to affect academic achievement and quality of life. Alterations in white -matter microstructure are associated with cognitive impairments in adolescents with congenital heart disease. This study aimed to identify microstructural alterations potentially associated with executive function deficits in adults with congenital heart disease. Diffusion tensor imaging and tract-based spatial statistics were conducted in 45 patients (18 females) and 54 healthy controls (26 females) aged 18–32 years. Fractional anisotropy of white matter diffusion was compared between groups and correlated with an executive function score, derived from an extensive neuropsychological test battery. Patients showed widespread bilateral reduction in fractional anisotropy (P < 0.05, multiple comparison corrected) compared to controls. Lower fractional anisotropy was driven by patients with moderate and severe defect complexity (compared to controls: P < 0.001). Executive function scores were lower in patients (P < 0.05) and associated with lower fractional anisotropy in the left superior corona radiata and the corticospinal tract (corrected P < 0.05). Our findings confirm alterations of white matter microstructure in adults with congenital heart disease, mainly in those patients of moderate to severe complexity. These alterations are associated with impairments in executive functioning. A better understanding of the neurocognitive deficits may help counselling and care of patients with congenital heart disease across their lifespan and have the potential to improve their outcome and quality of life.

Unusual coronary artery arrangement in D-transposition of the great arteries with ventricular septal defect.

A term female with prenatally diagnosed D-Transposition of the great arteries, large membranous ventricular septal defect with inlet extension, moderate secundum atrial septal defect, and large patent ductus arteriosus (Fig1) was born by scheduled caesarean section. Transthoracic echocardiogram confirmed the anatomy with both coronary arteries arising from a single sinus with separate ostia. The right coronary artery arose from right posterior facing sinus (Fig2). The left coronary artery arose anomalously from the same sinus adjacent to the right coronary artery ostium, coursing posterior to the aorta, with brief intramural and interarterial course before bifurcating into the left anterior descending and left circumflex coronary arteries (Figs3 and 4). As a result of this unique coronary pattern, she underwent unroofing of the intramural left coronary artery noted on opening the aortic root to the coronary ostium. Both coronary buttons were harvested and this large button was then divided into two buttons. The left coronary artery button was implanted with a trapdoor technique, right coronary artery button was implanted, and the remainder of the arterial switch procedure along with LeCompte maneuver was completed uneventfully, with closure of the atrial and ventricular septal defects. The post-operative course was uneventful and the patient was discharged on the seventh post-operative day. At discharge, the patient had normal biventricular systolic function, no residual intracardiac shunt, and robust antegrade flow in the reimplanted coronary arteries. The patient was growing well at the fourth month post-operative visit with normal biventricular function, patent coronaries, and outflow tracts.

Propeller flap: Orthoplastic approach for coverage of distal leg and ankle defects

BackgroundCovering soft tissue defects of the distal one-third of the leg and the Achilles tendon region and is a challenging problem for an orthopedic surgeon. With recent advancements in the anatomical knowledge of perforating vessels, perforator-pedicled propeller flaps have become increasingly popular in recent decades. We aimed to evaluate the clinical outcomes of our patients whose soft tissue defects in the distal leg were reconstructed with propeller flaps and assessed association of complications with age, gender, flap size and arc of rotation. MethodsPatients that had a reconstruction with a propeller flap at the ankle from 2013 to 2019 were retrospectively reviewed. The main indications for the propeller flap were small- and medium-sized soft tissue defects of the distal lower limb. 20 propeller flaps were applied to 19 patients (14 male, 5 female) for various lower extremity defects. ResultsThe mean follow-up duration was 2 years (range, 6 months to 6 years). The average flap size was 82 cm2 (range, 48–125 cm2). The flap was rotated 180 degrees in nine patients The source of the perforator vessel was the tibialis posterior artery in 14 cases, the peroneal artery in 4 cases, both the tibialis posterior and peroneal arteries in 1 case. Four complications (20 %) occured postoperatively. Two patients developed partial necrosis at the tip of the flap, and two patients developed superficial epidermolysis. No correlations were found between complications and flap size and the arc of rotation. ConclusionsThe propeller flap is a reliable option for reconstruction of small to moderate defects in the lower extremity with good clinical results and minimal donor-site morbidity. It is applicable for orthopedic surgeons who do not have microsurgical experience or an available microscope in the operating room.

Moderating oxygen deficiency induced better thermochromic properties of monoclinic vanadium dioxide thin films

Monoclinic vanadium dioxide (M-VO2) is a kind of typical thermal phase change materials, but its relatively high phase transition temperature (68 °C) and low solar modulation efficiency greatly hinder the applications as energy materials. In this work, well-crystalline M-VO2 were prepared by pulsed laser deposition (PLD) under the adjustable oxygen pressure range. By fine adjusting the low oxygen pressure (0.1–0.9 Pa), VO2 maintain the monoclinic crystal and excellent photoelectrical properties, even if oxygen deficiency and other defects exist. Results indicate that the phase-transition temperature (Tc) decreases with the decrease of oxygen pressures while the solar modulation efficiency (ΔTsol) increases with the decrease of oxygen pressures. Moreover, the M-VO2 thin films prepared with 0.3 Pa oxygen pressure showed the best photoelectric performance, in which the sheet resistance changes up to three orders of magnitude, the phase-transition temperature is 61 °C and the ΔTsol is as high as 8.3%. This work has demonstrated the role of moderate oxygen defects in optimizing the photoelectric properties of M-VO2, also provided a feasibility study on how to deposit pure M-VO2 by PLD.

Our Experience with Nasolabial Flaps in Soft Tissue Reconstruction of Oral Malignancy; Feasible Option in Rural Set Up.

In this era of microvascular expertise, free flaps are the preferred option by reconstructive surgeons but has technical limitation in rural set up. Nasolabial flaps has been widely mentioned in literature for smaller defect reconstruction with minimal morbidity. It is a robust flap for soft tissue reconstruction in early stage lesion of oral cavity. We present a series of single stage oral cavity reconstruction using inferiorly based islanded nasolabial flaps in small to moderate soft tissue defects. This is a retrospective study which included biopsy proven 10 patients diagnosed with early stage oral cavity malignancy. All the patients underwent single stage islanded nasolabial flap for small to moderate oral defects. Follow up of all patients were recorded with respect to clinical photographs, mouth opening, tongue mobility, deglutition, speech and patient satisfaction. All operated patients had good functional outcome in terms of swallowing, speech and tongue mobility. All patients were satisfactory with the postoperative results. In early stage oral malignancy patients, this option justifies a reliable and cost effective approach. Inferiorly based islanded nasolabial flaps provides a single stage, safer, faster and reliable option for small to moderate oral cavity defects.

Application of Appropriate Use Criteria for Echocardiography in Pediatric Patients with Palpitations and Arrhythmias.

Background:Before the integration of the pediatric appropriate use criteria (AUC) for initial transthoracic echocardiography (TTE) in the outpatient setting with our electronic medical record (EMR), there was a high proportion of “rarely appropriate” TTEs (17.2%) ordered for palpitations/arrhythmias. We studied appropriateness ratings and applicability of pediatric AUC on the initial outpatient evaluation of children with palpitations/arrhythmias after EMR integration and the yield of abnormal TTEs for these indications.Methods:We obtained data after the EMR integration of the AUC at our institution. The TTE ordering physician assigned the AUC indication and the corresponding appropriateness ratings autopopulated as: appropriate (A), may be appropriate (M), and rarely appropriate (R). We recorded the abnormal TTE findings.Results:A total of 463 TTEs were ordered for palpitations/arrhythmias. Overall, 142 (30.7%) were for A, 263 (56.8%) for M, 41 (8.8%) for R, and 17 (3.7%) for “unclassifiable” indications. Only 14 (3.0%) had abnormal TTE findings, of which none were for indications rated R. A TTE ordered for premature ventricular contractions in a 17-year-old revealed a significant abnormality (moderate atrial septal defect).Conclusions:The integration of AUC with the EMR significantly improved the appropriate utilization of TTE for palpitations and arrhythmias with a decrease in the proportion of TTEs for R indications (17.2%–8.8%). Although the yield of abnormal findings on TTE performed for palpitations/arrhythmias is quite low, the AUC ratings successfully stratified the indication with no abnormalities for indications rated R. These findings can guide future revisions of AUC indications and ratings to optimize resource utilization.

PULMONARY NOCARDIOSIS IN THE SETTING OF BRONCHIECTASIS

SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case Reports PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary nocardiosis is generally regarded as a rare infectious disease typically affecting immunocompromised individuals. However, one third of cases present in immunocompetent patients [1]. There is an increasing number of cases reported in individuals with bronchiectasis. We present an immunocompetent patient who presented with bronchiectasis due to pulmonary nocardiosis. CASE PRESENTATION: This case describes a 22-year-old male with no significant past medical history. He initially presented with fevers, chronic productive cough, and exertional dyspnea for approximately one year. Computed tomography (CT) of the chest demonstrated right middle lobe cicatricial atelectasis with mucoid bronchiectasis, lingular cylindrical bronchiectasis, basilar predominant tree-in-bud opacities, and mediastinal lymphadenopathy (Figure 1A-C). These findings prompted diagnostic bronchoscopic evaluation that revealed dilated bronchiectatic airways with copious tan sections in right middle and lower lobes. Additionally, spirometry was obtained, demonstrating moderate obstructive defect. Extensive evaluation for immunodeficiencies, pulmonary ciliary dyskinesia, and autoimmune disorders was unrevealing. Interestingly, cultures from bronchial washing grew out Nocardia cyriacigeorgica. Subsequently magnetic resonance imaging (MRI) brain was performed to rule out intracranial pathology and HIV screen was negative. He was started on treatment with sulfamethoxazole-trimethoprim. DISCUSSION: Pulmonary nocardiosis is a rare gram-positive bacterial infection typically affecting cell-mediated immunosuppressed patients, however increasing number of cases are presenting in immunocompetent patients. Most patients present with subacute or chronic cough, dyspnea, hemoptysis, chest pain, fever, night sweats, fatigue, and weight loss [2]. There have been few case reports describing pulmonary nocardiosis in the setting of bronchiectasis. Chronic obstructive lung disease and bronchiectasis have been described as risk factors pulmonary nocardiosis, however, the literature is sparse [3]. CONCLUSIONS: In immunocompetent patients presenting with bronchiectasis, maintaining high index of clinical suspicion for pulmonary nocardiosis is essential to ensure accurate diagnosis. Reference #1: Beaman BL, Burnside J, Edwards B, Causey W. Nocardial infections in the United States, 1972-1974. J Infect Dis. 1976;134(3):286–289. Reference #2: Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc. 2012;87(4):403-407. Reference #3: Woodworth MH, Saullo JL, Lantos PM, Cox GM, Stout JE. Increasing Nocardia incidence associated with bronchiectasis at a tertiary care center. Ann Am Thorac Soc 2017; 14: pp. 347-354. DISCLOSURES: No relevant relationships by Callie Duckworth, source=Web Response No relevant relationships by Armin Krvavac, source=Web Response

Gender-specific Anatomical Distribution of Internal Pudendal Artery Perforator: A Radiographic Study for Perineal Reconstruction.

Background:Cancer, trauma, infection, or radiation can cause perineal defects. Fasciocutaneous flaps based on perforator vessels (PV) from the internal pudendal artery (IPA) provide an ideal reconstructive option for moderate defects. We hypothesized that, due to gender differences in the pelvic–perineal region, the anatomical distribution of PV differs between genders.Methods:Computed tomography angiographies from male and female patients without pelvic–perineal pathologies were retrospectively analyzed to study the vascular anatomy of the IPA. The number, size, type, and distribution of PV were recorded and compared between genders. Four anatomical regions were defined to describe the distribution of PV on each perineal side: anterior (A), anterior-central (AC), central-posterior (CP), and posterior (P).Results:A total of 63 computed tomography angiographies were analyzed (men, 31; women, 32). Each IPA provides 2 ± 1 PV and 5 ± 2 terminal (cutaneous) branches: in both genders, 85% of PV are septocutaneous (15% musculocutaneous). In women, 70.5% of PV are located in AC, 28.2% in CP, 1.2% in A, and 0% in P: average diameter of the PV is 2.4 ± 0.3 mm. In men, 53.7% of PV are located in CP, 43.1% in AC, 3.3% in A, and 0% in P: average diameter of the PV is 2.8 ± 0.5 mm. Gender-specific differences in anatomical distribution of PV are significant (P < 0.001).Conclusions:Number, size, and type of terminal branches of PV of the IPA are consistent between genders, but their distribution is different, with women having an anterior predominance. Knowledge of gender-specific anatomy can guide preoperative planning and intraoperative dissection in flap-based perineal reconstruction

Isotropic high softening point petroleum pitch-based carbon as anode for high-performance potassium-ion batteries

Soft carbon materials are considered as promising anodes for potassium-ion batteries (KIBs) due to their low cost, ease of available, excellent electronic conductivity and tunable interlayer distance. However, they still exhibit unsatisfying performance for K-ions storage owing to the serious volume expansion and sluggish kinetics when forming potassium intercalation compounds. To date, the bulk soft carbon anodes for outstanding capacity of potassium storage have been rarely studied. Herein, a unique bulk soft carbon has been synthesized via a facile pyrolysis method, which shows a high reversible capacity of 343.2 mA h g−1, excellent rate capability, and good cycling performance (a retention of 86.2% at 100 mA g−1 after 100 cycles). The soft carbon with larger interlayer spacing and moderate defects can not only facilitate ion diffusion but also provide active sites for K-ions storage, contributing to an outstanding capacity and excellent rate performance. In addition, full cells constructed with the obtained soft carbon as anode also exhibit a good performance with a capacity of 201 mA h g−1. Considering the cost issue, practical application and electrochemical performance, this work provides a strategy for manufacturing low cost and brilliant electrochemical performance KIBs anode material.

Comparison of Test Setups for the Experimental Evaluation of the Primary Fixation Stability of Acetabular Cups.

Sufficient primary fixation stability is the basis for the osseointegration of cementless acetabular cups. Several test methods have been established for determining the tilting moment of acetabular press-fit cups, which is a measure for their primary fixation stability. The central aim of this experimental study was to show the differences between the commonly used lever-out test method (Method 1) and the edge-load test method (Method 2) in which the cup insert is axially loaded (1 kN) during the tilting process with respect to the parameters, tilting moment, and interface stiffness. Therefore, using a biomechanical cup block model, a press-fit cup design with a macro-structured surface was pushed into three cavity types (intact, moderate superior defect, and two-point-pinching cavity) made of 15 pcf and 30 pcf polyurethane foam blocks (n = 3 per cavity and foam density combination), respectively. Subsequently, the acetabular cup was disassembled from the three artificial bone cavities using the lever-out and the edge-load test method. Tilting moments determined with Method 1 ranged from 2.72 ± 0.29 Nm to 49.08 ± 1.50 Nm, and with Method 2, they ranged from 41.40 ± 1.05 Nm to 112.86 ± 5.29 Nm. In Method 2, larger areas of abrasion were observed in the artificial bone cavity compared to Method 1. This indicates increased shear forces at the implant–bone interface in the former method. In conclusion, Method 1 simulates the technique used by orthopedic surgeons to assess the correct fit of the trial cup, while Method 2 simulates the tilting of the cup in the acetabular bone cavity under in situ loading with the hip resultant force.

Safety and feasibility of trial of labor in pregnant women with cesarean scar diverticulum.

ObjectiveLiterature on trial of labor after cesarean section (TOLAC) in women with isthmoceles is scarce because of complications associated with the procedure. This study investigated TOLAC's safety and feasibility in patients with isthmoceles.MethodsThe study group comprised 34 pregnant women with isthmoceles who vaginally delivered. The control group comprised 102 pregnant women without isthmoceles who vaginally delivered during the same period. Scar diverticula were measured using color Doppler ultrasonography; between-group delivery outcomes were compared.ResultsOf the study group patients, 27/34 had isthmoceles diagnosed by ultrasound before pregnancy. Nineteen (70.37%) of these patients had mild defects and eight (29.63%) had moderate defects. The scar diverticula's mean length, depth, and width were 1.05 ± 0.62, 0.54 ± 0.28, and 1.20 ± 0.70 cm, respectively. The residual muscle layer's mean thickness was 0.27 ± 0.07 cm. The mean diverticulum depth/residual muscular thickness ratio was 2.39 ± 2.58. The duration of the first stage of labor was significantly shorter and the neonatal weight was significantly lower in the study group than control group.ConclusionSuccessful vaginal delivery is possible for women with mild and moderate isthmoceles. Further large-scale studies are needed to improve TOLAC's safety in pregnant women with isthmoceles.

Correlation between quantitative multi-detector computed tomography lung analysis and pulmonary function tests in chronic obstructive pulmonary disease patients

BackgroundChronic obstructive pulmonary disease [COPD] is a very common disease in developing as well as in developed countries. Using CT has a growing interest to give a phenotypic classification helping the clinical characterization of COPD patients. So, the aim of the present study was to evaluate whether there was a significant correlation between quantitative computed tomography lung analysis and pulmonary function tests in chronic obstructive pulmonary disease patients.ResultsThe study included 50 male patients with a mean age of 62.82 years ± 8.65 years standard deviation [SD]. Significant correlation was found between the pulmonary function tests [FEV1 and FEV1/FVC ratio], and all parameters of quantitative assessment with – 950 HU [the percentage of low-attenuation areas (% LAA)]. Pulmonary function tests according to GOLD [Global Initiative for Chronic Obstructive Lung Disease] guidelines revealed that 4% had normal pulmonary function, 8% had mild obstructive defect, 32% had moderate obstructive defect, 26% had severe obstructive defect, and 30% had very severe obstructive defect.ConclusionAutomated CT densitometry defining the emphysema severity was significantly correlated with the parameters of pulmonary function tests and providing an alternative, quick, simple, non-invasive study for evaluation of emphysema severity. Its main importance was the determination of the extent and distribution of affected emphysematous parts of the lungs especially for selecting the patients suitable for the lung volume reduction surgery.

Ischaemic burden and changes in absolute myocardial perfusion after chronic total occlusion percutaneous coronary intervention.

The aim of this study was to explore the relationships between ischaemic burden and changes in absolute myocardial perfusion following chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI). A total of 193 consecutive patients underwent [15O]H2O positron emission tomography prior to and three months after successful CTO PCI. Change in perfusion defect size, quantitative hyperaemic myocardial blood flow (MBF) and coronary flow reserve (CFR) within the CTO area were compared among patients with limited (0-1 segment, N=15), moderate (2-3 segments, N=61) and large (≥4 segments, N=117) perfusion defects. Median reductions in defect size were 1 [0-1], 2 [1-3], and 4 [2-5] segments in patients with a limited, moderate and large defect (all comparisons p<0.01). Hyperaemic MBF and CFR improved significantly regardless of baseline defect size (overall between groups p=0.45 and p=0.55). After stratification of patients to a low, intermediate or high tertile according to baseline hyperaemic MBF or CFR levels, changes in hyperaemic MBF and CFR after CTO PCI were comparable between tertiles (overall p=0.75 and p=0.79). Major reductions in ischaemic burden can be achieved following CTO PCI, with more defect size reduction in patients with a larger perfusion defect, whereas hyperaemic MBF and CFR improve significantly irrespective of their baseline values or perfusion defect size.