Multiple Procedures Research Articles

Spinal column shortening with single-stage prone lateral vertebral osteotomy for tethered cord syndrome: illustrative case.

Tethered cord syndrome (TCS) is a rare neurological disorder characterized by longitudinal stretching on the distal end of the spinal cord. The condition commonly manifests in lumbosacral and lower-extremity pain and weakness, sensory disturbances, and incontinence. Traditionally, tethered cord release has been the first-line management for TCS, but retethering and complications such as cerebrospinal fluid leakage are commonly reported. As a result, spinal column shortening (SCS) vertebral osteotomy has emerged as a potential alternative. Herein, the authors describe the first single-stage prone lateral SCS vertebral osteotomy with simultaneous posterior exposure in a 48-year-old male patient with multiple prior direct detethering procedures. The authors highlight the case presentation, operative technique, and postoperative course. Following surgery, there were no immediate surgical complications, and the patient noted clinical improvement in his radicular pain and neurological function. This case further supports SCS vertebral osteotomy as an effective treatment option for patients with TCS. It also demonstrates the potential for a single-stage lateral approach with posterior exposure as a minimally invasive option for spinal shortening procedures. However, further studies using expanded cohorts and assessing various surgical techniques are warranted. https://thejns.org/doi/10.3171/CASE24185.

The Use of the Pedicled Nonislanded Foot Fillet Flap to Avoid an Above-the-Knee Amputation after Trauma.

Lower extremity trauma can have a devastating effect on the quality of the life of patients. To avoid limb amputation and its associated social stigma, many patients spend years undergoing multiple costly procedures, with prolonged hospital stays, all the while hoping for an elusive limb salvage. People with lower limb amputation experience higher energy requirements for walking, reduced aerobic capacity, and slower walking speeds, when compared with people with normal limbs. A below-knee amputation (BKA) is functionally superior to an above-knee amputation. Between 2012 and 2023, five patients underwent BKAs with a nonislanded foot fillet flap reconstruction of the BKA stump. Four of these patients had undergone previous multiple procedures in attempts at limb salvage. While two patients had sustained recent trauma, three were operated on electively. All the BKA stumps healed without any complications. Only one patient complained of phantom limb pain. One patient will require the reconstruction of a lateral knee collateral ligament. This case series demonstrates the versatility of the pedicled foot fillet flap in addressing the different complications of lower extremity injury that may result in an unusable limb. The utility of this technique is especially valuable in low-resource settings where the built environment may be unfriendly to nonbipedal ambulation, and an urgent need for a return to economic productivity. Because prostheses are fairly accessible in Kenya, return to ambulation and economic productivity are anticipated following a BKA.

Construction of Multiply Guaranteed DNA Sensors for Biological Sensing and Bioimaging Applications.

Nucleic acids exhibit exceptional functionalities for both molecular recognition and catalysis, along with the capability of predictable assembly through strand displacement reactions. The inherent programmability and addressability of DNA probes enable their precise, on-demand assembly and accurate execution of hybridization, significantly enhancing target detection capabilities. Decades of research in DNA nanotechnology have led to advances in the structural design of functional DNA probes, resulting in increasingly sensitive and robust DNA sensors. Moreover, increasing attention has been devoted to enhancing the accuracy and sensitivity of DNA-based biosensors by integrating multiple sensing procedures. In this review, we summarize various strategies aimed at enhancing the accuracy of DNA sensors. These strategies involve multiple guarantee procedures, utilizing dual signal output mechanisms, and implementing sequential regulation methods. Our goal is to provide new insights into the development of more accurate DNA sensors, ultimately facilitating their widespread application in clinical diagnostics and assessment.

Assessing Micronutrients in Soil with a New Chemical Extractant Using Isotopic Dilution Techniques: Linkages to Labile Fractions in Soil

ABSTRACT With the purpose of economizing the routine soil testing for micronutrients and avoiding the use of multiple soil extraction procedures, a laboratory investigation was attempted to evaluate a new chemical extractant for assessing the availability of common micronutrients (Fe, Cu, Mn, Zn, Mo, and B) in soils of widely varying properties (n = 32). The new extractant designated as OM-MES-VERA# contained 0.01 M oxalic acid, 0.02 M maleic acid, 0.02 M 2-(N-Morpholino) ethane sulfonic acid (MES), 0.0025 M ethylene diamine tetraacetic acid di-sodium salt, 0.02 M acetic acid, and 0.1% polyacrylamide (final pH adjusted to 6.0). OM-MES-VERA extracted significantly higher amounts of micronutrient cations and B from soils compared to the conventional diethylene triamine pentaacetic acid (DTPA, pH 7.3) extractable micronutrient cations and hot water soluble B, respectively, but lesser amount of Mo compared to Mehlich-3 universal extractant. Soil test values by both OM-MES-VERA- and conventional extractants were correlated with soil properties. The labile (E and L) values of micronutrient cations and Mo estimated by isotopic dilution method, ammonium bicarbonate-DTPA, pH 7.6 extractable soil B (as an estimate of E for B) and B concentration in maize (as an estimate of L for B) were successfully regressed on soil test values of micronutrients by OM-MES-VERA and conventional soil extractants except in the case of DTPA (pH 7.3) for E-value of Fe and L-value of Mn. The OM-MES-VERA extractant can be considered to assess the availability of common micronutrients in soils of diverse soil properties.

Can One Pool Over Site in a Multi-Site Study With Categorical Item Measuring Instruments?: A Multiple Testing Procedure

Can One Pool Over Site in a Multi-Site Study With Categorical Item Measuring Instruments?: A Multiple Testing Procedure

Endoscopic Retrograde Cholangiopancreatography-Related Procedures for the Differential Diagnosis of Isolated Immunoglobin G4-Related Sclerosing Cholangitis and Perihilar Cholangiocarcinoma.

Differential diagnosis of isolated immunoglobin (Ig)G4-related sclerosing cholangitis (IgG4-SC) and cholangiocarcinoma is challenging. We aimed to clarify the role of endoscopic retrograde cholangiography (ERCP)-related procedures in the differential diagnosis of isolated IgG4-SC and perihilar cholangiocarcinoma (PHCC). Seven patients with hilar-type isolated IgG4-SC diagnosed at Hiroshima University Hospital and sixty-five patients with surgically resected invasive PHCC were enrolled, and the diagnostic yields of intraductal ultrasonography (IDUS), peroral cholangioscopy (POCS), and pathological examinations were determined. In six of seven (86%) patients with isolated IgG4-SC, the stricture was in the perihilar bile duct. IDUS showed that symmetrical wall thickening (40% vs. 5%, p = 0.04), homogeneous internal echo (80% vs. 5%, p < 0.001), and smooth outer margins (80% vs. 6%, p < 0.001) were more frequent in isolated IgG4-SC than in PHCC. POCS showed a smooth mucosal surface more frequent in isolated IgG4-SC (75% vs. 7%, p = 0.006). Only one patient had two pathological findings characteristic of IgG4-SC. The sensitivity for diagnosing PHCC was 81% using two or more combined sampling methods. Pathological examinations have limitations in the differential diagnosis of isolated-IgG4-SC and PHCC, and a diagnostic strategy that combines multiple ERCP-related procedures, including IDUS and POCS, is recommended.

A Unique and Effective Bypass Technique to Treat Partially Thrombosed Giant Distal Anterior Cerebral Artery Aneurysms in Extremely Narrow Surgical Corridors

Surgical treatment of large or giant thrombosed anterior cerebral artery (ACA) aneurysms often involves revascularization. Herein, we describe a unique and effective bypass technique to treat partially thrombosed giant distal ACA aneurysms in extremely narrow surgical corridors. A 68-year-old man underwent aneurysm trapping and ACA revascularization for a partially thrombosed giant ACA aneurysm in a surgical corridor that was narrow due to anatomic factors. By combining a side-to-side anastomosis and an end-to-side anastomosis at a single anastomotic site, we successfully redirected blood flow from the left pericallosal artery to the right pericallosal and callosomarginal arteries. Postoperatively, cerebral angiography showed that the blood flow in the aneurysm had disappeared, and the bypass remained open. The patient's functional disability gradually improved, and he reported consistently positive outcomes at the 6-month postoperative follow-up examination. This revascularization technique may represent an effective novel treatment option, particularly when multiple revascularization procedures are required within a narrow surgical field.

De novo primary malignant lymphoma of the dura following recurrent episodes of subdural abscess presenting as chronic subdural hematoma: illustrative case.

Chronic inflammation of the thorax, as in tuberculosis-related pyothorax, can cause secondary malignant lymphomas. However, primary malignant lymphoma of the central nervous system, specifically of the dura mater, developing after intracranial infection or inflammation has rarely been reported. Herein, the authors describe a case of primary dural lymphoma that developed secondary to subdural empyema, with an initial presentation mimicking a chronic subdural hematoma. A 51-year-old man had undergone single burr hole drainage for subdural empyema 2 years prior. The patient subsequently underwent multiple craniotomy and drainage procedures, with successful remission of the subdural empyema. He was subsequently referred to the authors' hospital approximately a year after his initial treatment because of a recollection of subdural fluid, which was suspected to be recurrent empyema. After another single burr hole drainage, which revealed only a subdural hematoma, a histopathological diagnosis of B-cell lymphoma of the dural/subdural membrane was made. Subsequent radiation therapy was completed, with good local control and no recurrence of the subdural hematoma confirmed at 2 months posttreatment. Intracranial lymphoma triggered by chronic inflammation is rare but should be considered a differential diagnosis in subdural hematomas for which the background pathology is unclear. https://thejns.org/doi/10.3171/CASE24153.

A retrospective study of the anterolateral thigh perforator flap in the treatment of chronic osteomyelitis of the leg with skin defects

BackgroundAs a chronic inflammatory process, chronic osteomyelitis is caused by bacterial infections that lead to bone destruction. This disease is more common in patients with open fractures and those undergoing multiple surgical procedures after trauma. We aimed to provide a comprehensive overview and critical assessment of the therapeutic efficacy of the anterolateral thigh (ALT) perforator flap in the management of chronic osteomyelitis with dermatologic and soft tissue imperfections localized in the lower extremity. MethodsA retrospective analysis involving a cohort of 16 patients who underwent ALT perforator flap reconstruction for the management of chronic osteomyelitis in the calf region that manifested with integumentary deficiencies was conducted. ResultsDuring the follow-up period spanning from 4 months to 2 years, all 16 patients who underwent ALT perforator flap transplantation exhibited flap viability. Among these cases, 15 patients made a full recovery from the infection and 1 patient had partial survival. Among the 15 cases, 2 patients developed vascular crisis (owing to venous thrombosis during surgical exploration). One patient had a relapse of the disease 1-year post-surgery. The success rate of this surgical method was 15/16, and the surgical complications included flap crisis, flap necrosis, delayed wound healing, and recurrence of infection. ConclusionThe ALT perforator flap, which can cover bone and soft tissues and effectively control infections, can be applied to the treatment of chronic osteomyelitis of the lower limbs with skin defects. Overall, the muscle flap fills the dead space and medullary cavity and skin flap covers the skin defect.

The Learning Curve of Total Breast Reconstruction With Autologous Fat Transfer.

Total breast reconstruction with autologous fat transfer (AFT) is a relatively new breast reconstruction method. Although AFT was predominantly used to correct postsurgical defects, the surgical skills of a total breast reconstruction with AFT are different and can be facilitated for novices to accelerate their learning process. This study aims to assess the learning curve of plastic surgeons in total breast reconstruction with AFT in the Netherlands. A mixed-methods study was performed based on the multicenter randomized clinical BREAST trial data. For the qualitative analysis, semistructured interviews were conducted. To test hypotheses derived from the qualitative data, retrospective data analysis was performed using multilevel linear regression analysis of the patients undergoing AFT as a total breast reconstruction method. The interviews revealed that plastic surgeons need to perform the procedure several times to learn and experience the technical details of total breast reconstruction with AFT. Learning and improving this technique works best by scrubbing in with an expert. Before plastic surgeons learn the optimal volume of fat reinjection over time, they tend to inject too little fat and subsequently too much fat over multiple procedures. With more experience, the rigottomy technique becomes more important. Besides technical details, managing patient expectations before starting treatment is paramount. Multilevel linear regression revealed a significant decrease ( P < 0.001) in the number of surgical procedures and the total injected volume ( P = 0.002) to complete a total breast reconstruction with AFT. This is the first study that explores the learning curve involved in using AFT as a total breast reconstruction method. The feeling of when fat transfer is sufficient, and how to release scars for a good result without causing seromas, is best learned by scrubbing in with experienced colleagues during several procedures, interchanged with starting one's own practice.

Case Study on the Advancements in Diagnosis and Treatment Technologies for Military Personnel with Complex Explosive Injuries

Case(s): A 51-year-old military personnel with severe limb injury from mortar shelling, admitted to Orthopedic Traumatology Department, Ternopil Regional Hospital, Ukraine.Conclusions: Explosive injuries typically arise from the detonation of devices such as landmines, improvised explosive devices, or grenades, causing harm through blast, fragmentation, and thermal effects. Despite a delayed presentation to medical care, the patient underwent multiple debridement procedures, including Vacuum-Assisted Closure therapy, and vascular reconstruction, leading to limb salvage. This case underscore needs for timely medical care, addressing risks of mine blasts and cold weather injuries through training.

Bundle care approach to reduce device associated infections in post-living-donor-liver transplantation in a tertiary care hospital, Egypt

BackgroundDevice-associated infections (DAIs) are a significant cause of morbidity following living donor liver transplantation (LDLT). We aimed to assess the impact of bundled care on reducing rates of device-associated infections.MethodsWe performed a before-and-after comparative study at a liver transplantation facility over a three-year period, spanning from January 2016 to December 2018. The study included a total of 57 patients who underwent LDLT. We investigated the implementation of a care bundle, which consists of multiple evidence-based procedures that are consistently performed as a unified unit. We divided our study into three phases and implemented a bundled care approach in the second phase. Rates of pneumonia related to ventilators [VAP], bloodstream infections associated with central line [CLABSI], and urinary tract infections associated with catheters [CAUTI] were assessed throughout the study period. Bacterial identification and antibiotic susceptibility testing were performed using the automated Vitek-2 system. The comparison between different phases was assessed using the chi-square test or the Fisher exact test for qualitative values and the Kruskal-Wallis H test for quantitative values with non-normal distribution.ResultsIn the baseline phase, the VAP rates were 73.5, the CAUTI rates were 47.2, and the CLABSI rates were 7.4 per one thousand device days (PDD). During the bundle care phase, the rates decreased to 33.3, 18.18, and 4.78. In the follow-up phase, the rates further decreased to 35.7%, 16.8%, and 2.7% PDD. The prevalence of Klebsiella pneumonia (37.5%) and Methicillin resistance Staph aureus (37.5%) in VAP were noted. The primary causative agent of CAUTI was Candida albicans, accounting for 33.3% of cases, whereas Coagulase-negative Staph was the predominant organism responsible for CLABSI, with a prevalence of 40%.ConclusionThis study demonstrates the effectiveness of utilizing the care bundle approach to reduce DAI in LDLT, especially in low socioeconomic countries with limited resources. By implementing a comprehensive set of evidence-based interventions, healthcare systems can effectively reduce the burden of DAI, enhance infection prevention strategies and improve patient outcomes in resource-constrained settings.

Multiple exponentially weighted moving average control schemes for monitoring and diagnostics of correlated quality variables of different types with individual observations

In the era of big data analytics, more data, in terms of quantity and variety, are being collected for quality control purposes, thus leading to new challenges, especially for multivariate statistical process control (MSPC). One such challenge, which has received very little attention, is multivariate control chart (MCC) for monitoring correlated quality variables of different types. A recent study by Huang et al. (2023), which develops a Shewhart type MCC, is the first attempt to tackle such a challenge. The proposed chart of Huang et al. (2023), which utilizes the step-down multiple testing procedure of Holm (1979), not only can monitor correlated variables of different types, but also can provide instantaneous diagnostics of which parameters are out of control when the chart signals. In this study, we adapt and extend the methodology of Huang et al. (2023) to develop an exponentially weighted moving average (EWMA) chart specifically for the case when the sample size is one. The proposed chart is shown to be effective in detecting parameter changes as well as diagnosing which parameters are out of control when the chart signals.

1096 The African Surgical Outcomes Study in Paediatric Patients (ASOS-Paeds) and Global Paediatric Perioperative Mortality - a Meta-analysis

Abstract Aim There is little data for surgical outcomes of children in Africa. This is of particular importance as children constitute 40% of the African population, compared to a global average of 25%. As part of ASOS-Paeds - a prospective cohort study of children undergoing surgery in African countries, we undertook a meta-analysis to synthesise the evidence on global paediatric perioperative mortality. Method We searched MEDLINE, Embase and WHO Global Index Medicus for studies published within the last decade, reporting paediatric perioperative mortality. We included studies with ≥200 children that reported perioperative mortality for multiple surgical specialties and procedures. Perioperative mortality was defined as death within 30 days of surgery. For meta-analysis, proportions were combined using a random effects model. Results After screening 13,258 s and reviewing 158 full-text reports, data from 9 studies were eligible for synthesis along with data from ASOS-Paeds. The meta-analysis included 579,733 children from Africa, Europe, and North America. The pooled perioperative mortality rate per 1,000 children (95% CI) was 17.91 (9.78, 26.04) in Africa compared to 2.18 (0.95, 3.42) in Europe and North America. This equates to excess paediatric perioperative mortality in Africa between 6 (in the best-case scenario) to 25 (in the worst-case scenario) per 1,000 children. Conclusions Perioperative mortality for children undergoing surgery in Africa is 8-fold higher than in Europe and North America. Access to safe and affordable anaesthesia and surgery should be a public health priority and urgent action is needed to improve surgical outcomes for children in Africa.

Clinical and molecular risk factors for repeat interventions due to symptomatic uterine leiomyomas

BackgroundRepeat leiomyoma occurrence or even reintervention is common after myomectomy. Little is known about the factors related to repeat interventions. ObjectivesThis study aimed to determine the frequency of leiomyoma-related reintervention after an initial laparoscopic or abdominal myomectomy and to analyze both clinical and molecular risk factors for reinterventions. Another objective was to define the frequency of clonally related tumors from repeat operations. Study DesignThis retrospective cohort study included 234 women who had undergone laparoscopic or abdominal myomectomy in 2009-2014. Information on repeat leiomyoma-related interventions as well as on other clinical factors was collected from medical records after a median follow-up time of 11,4 years (range 7,9-13,8 years) after the index procedure. The effect of clinical risk factors on the risk of reintervention was analyzed by the Kaplan-Meier estimator and the Cox proportional hazards model. For molecular analyses, we examined the mutation profiles of 133 formalin-fixed paraffin-embedded leiomyoma samples from 33 patients with repeat operations. We screened the tumors for the three primary leiomyoma driver alterations—MED12 mutations, HMGA2 overexpression, and FH-deficiency—utilizing Sanger sequencing and immunohistochemistry. To further assess the clonal relationship of the tumors, we executed whole-exome sequencing for 52 leiomyomas from 21 patients who exhibited the same driver alteration in tumors obtained from multiple procedures. ResultsReintervention rate at 11,4 years after myomectomy was 20% (46/234). Number of leiomyomas removed at the index myomectomy was a risk factor (hazard ratio 1.21; 95% confidence interval 1.09-1.34). Age at index myomectomy (hazard ratio 0.94; 95% confidence interval 0.89-0.99) and postoperative parity (hazard ratio 0.23; 95% confidence interval 0.09-0.60) were protective factors. Molecular characterization of tumors from index and non-index operations confirmed a clonal relationship of the tumors in 3/33 (9%) patients. None of the leiomyomas harboring a MED12 mutation —the most common leiomyoma driver— were confirmed clonally related. FH-deficiency was detected in repeat leiomyomas from 3/33 (9%) patients. All these patients harbored a germline FH mutation, which is distinctive for the hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome. Finally, we identified three (3/33; 9%) patients with two tumors each displaying somatic mutations in a recently identified novel leiomyoma driver gene, YEATS4. All YEATS4 mutations were different and thus the tumors were not clonally related. ConclusionOur study shows that reintervention is common after surgical myomectomy. Uterine leiomyomas typically develop independently, but some share a clonal origin. Repeat leiomyoma occurrence may be due to genetic predisposition, such as a germline FH mutation. Distinct somatic YEATS4 mutations identified in multiple leiomyomas from the same patient indicate a possible role for YEATS4 in repeat leiomyomas.

LVAs in a Pedicled SIEA Flap for the Treatment of Recurrent Lymphocele of the Groin Using Superficial Veins of the Flap for Lymphovenous Anastomosis: A Case Report and Literature Review.

Persistent lymphocele of the groin is a complication of groin surgery that can severely impact the quality of life. The restoration of the interrupted lymphatic pathway is considered by many authors the ideal treatment to prevent a recurrence. However, multiple aspiration procedures and surgical revisions can compromise the availability of local veins needed for a lymphovenular bypass surgery. In addition, surgical debridement of a long-standing lymphocele can generate extensive dead space and contour deformity. A flap delivering additional venules for trans-flap lymphovenular anastomoses (LVAs) can overcome both problems by providing soft tissue and competent veins harvested outside the zone of injury. A successful case of severe groin lymphocele treated with trans-flap LVAs from an abdominal-based flap is presented. The patient was referred to us for a recurrent lymphocele developed in the right groin after lipoma excision that persisted despite multiple surgical attempts. After the identification of patent and draining inguinal lymphatic vessels, a pinch test was used to design a mini-abdominoplasty superficial inferior epigastric artery flap. The superficial veins of the cranial incision were identified and anastomosed to the lymphatic vessels after the pedicled flap harvested and insetted in the groin. The early restoration of lymphatic drainage and the optimal aesthetic outcome supports the combined approach offered by trans-flap LVAs as a valuable therapeutic option for severe and persistent lymphocele.

Mechanical Thrombectomy Workshops Improve Procedural Knowledge and Skills Among Neurointerventional Teams in Low- to Middle-Income Countries.

While mechanical thrombectomy (MT) is proven to be lifesaving and disability sparing, there remains a disparity in its access in low- to middle-income countries. We hypothesized that team-based MT workshops would improve MT knowledge and skills. We designed a 22-hour MT workshop, conducted as 2 identical events: in English (Jamaica, January 2022) and in Spanish (Dominican Republic, May 2022). The workshops included participating neurointerventional teams (practicing neurointerventionalists, neurointerventional nurses, and technicians) focused on acute stroke due to large vessel occlusion. The course faculty led didactic and hands-on components, covering topics from case selection and postoperative management to device technology and MT surgical techniques. Attendees were evaluated on stroke knowledge and MT skills before and after the course using a multiple choice exam and simulated procedures utilizing flow models under fluoroscopy, respectively. Press conferences for public education with invited government officials were included to raise stroke awareness. Twenty-two physicians and their teams from 8 countries across the Caribbean completed the didactic and hands-on training. Overall test scores (n=18) improved from 67% to 85% (P<0.002). Precourse and postcourse hands-on assessments demonstrated reduced time to completion from 36.5 to 21.1 minutes (P<0.001). All teams showed an improvement in measures of good MT techniques, with 39% improvement in complete reperfusion. Eight teams achieved a Thrombolysis in Cerebral Infarction score of 3 on pre-course versus 15 of 18 teams on post-course. There was a significant reduction in total potentially dangerous maneuvers (70% pre versus 20% post; P<0.002). Universally, the workshop was rated as satisfactory and likely to change practice in 93% Dominican Republic and 75% Jamaica. A team-based hands-on simulation approach to MT training is novel, feasible, and effective in improving procedural skills. Participants viewed these workshops as practice-changing and instrumental in creating a pathway for increasing access to MT in low- to middle-income countries.

Ultrasonographic Characterizations of Radial Artery for Transradial Approach in the Saudi Population: A Pilot Study.

Background The radial artery originates from the brachial artery at the level of the neck of the radius in the cubital fossa. It has multiple branches all over its course, and it is an important artery for multiple procedures across several fields. Objectives The objective of this article is to assess the size and characteristics of the radial artery in the Saudi population for the transradial approach. It aims to compare the diameters of the distal and proximal radial arteries using ultrasonography and determine the clinical significance of the findings in selecting an appropriate catheter size among different demographic groups. Additionally, the study aims to contrast the obtained results with international standards to provide a comprehensive analysis of the radial artery characteristics in the Saudi population. Methods A pilot study was conducted at a Medina region hospital in Madinah from December 2022 to July 2023. An ultrasonographic assessment of the right radial artery was performed on a sample of 45 volunteers. Results Our results showed a significantly larger mean diameter of the right ulnar artery in males compared to females. No other significant differences were observed in the characteristics of the right proximal radial artery (PRA), distal radial artery (DRA), or ulnar artery between genders. Significant differences in arterial characteristics were observed across different body mass index (BMI) categories for several parameters. Depth measurements in the right PRA displayed notable differences across age groups, and the ulnar artery showed significant variability among age categories. No statistically significant differences were found in arterial characteristics across smoking categories. Conclusion Our study on Saudi Arabian radial artery ultrasonography reveals potential clinical correlations, highlighting the influence of age and BMI on arterial characteristics. Further research is needed to confirm these findings and explore demographic determinants.

Beyond the Baker's Cyst: Pathology and Variant Anatomy in the Popliteal Fossa on Routine Knee MRI

Primary evaluation of the knee focuses on evaluation of cartilaginous degeneration, meniscal injury, ligamentous or tendinous abnormality, and bony lesions, rather than the posterior and extracapsular popliteal fossa. A succinct review of normal popliteal fossa anatomy and normal fat planes is key to recognizing clinically significant pathology and variant anatomy. Abnormal insertion of the medial head of the gastrocnemius, or an accessory head of the gastrocnemius, can increase the risk of popliteal artery entrapment, an underrecognized cause of posterior calf and knee pain. Abnormal branching and course of the popliteal artery can increase risk of surgical vulnerability during multiple knee procedures, including arthroscopy and high tibial osteotomy. Finally, not all masses in the popliteal fossa are Baker's cysts; synovial sarcomas, vascular malformations, and other tumors can present in this anatomic space and can mimic popliteal cysts.

An analysis of the predictive factors for stone clearance at primary ureteroscopy

BackgroundUreteric colic is a common emergency urological presentation [1]. When operative intervention is required, retrograde ureteroscopy is the most common approach. There are multiple treatment strategies including primary ureteroscopy (URS), staged ureteroscopy, and deferred ureteroscopy following ureteric stent placement. The approach is based on a number of clinical and stone factors. This study assesses the factors which predict stone clearance at the initial procedure.AimsAll patients diagnosed with an obstructing ureteric stone who were managed operatively in a consecutive 12-month period were included. Patients were evaluated for stone clearance following a single or multiple procedures. A number of factors including stone size, location, gender, age and pre-operative laboratory results were evaluated for association with stone clearance at index procedure. Multivariate logistic regression analyses were performed to produce odds ratios (OR) with confidence interval (CI) at 95% and significance values P < 0.05.ResultsOne hundred and seventy patients were included in the final analysis. Stone clearance following the index procedure was achieved in 57% (n = 100) of patients. Predictors of successful stone clearance at index procedure were stone size < 6 mm, male gender and distal stone location (p < 0.05). Proximal stone location, stone size > 10 mm and elevated c-reactive protein (CRP) were associated respectively with multiple procedures to achieve stone clearance (p < 0.05).ConclusionsAcute ureteric stones can be managed with a number of treatment strategies. This study identifies factors which predict stone clearance at index procedure. These results will help urologists accurately counsel patients when undertaking operative management for ureteric colic.