Need For Further Surgical Intervention Research Articles

Can systemic antibiotics reduce the need for surgical intervention in treating peri-implantitis?

A retrospective cohort design was used to assess the long-term clinical effectiveness of systemic amoxicillin and metronidazole, used adjunctively with non-surgical peri-implantitis treatment (NST) and whether it prevents the need for further surgical interventions. Of the 57 peri-implantitis patients examined, 45 patients were included in this study. The participants were divided into two subgroups in accordance to who had received NST with or without systemic antibiotics. Selection was based on prior participation in a three-month randomised control trial, ensuring comparability of data regarding peri-implantitis severity and treatment history. Data were extracted pre-treatment, 3-months post-treatment and at a long-term follow-up interval of 36 months. The primary outcome was the need for additional surgical intervention and was analysed via Kaplan-Meier analysis and Cox regression. A multitude of secondary clinical outcomes were evaluated using parametric and non-parametric tests, including peri- implant probing depth, bleeding scores and treatment success. Overall, 62.2% of the 45 NST patients did not need surgical peri-implantitis treatment: 73.9% of the subgroup with antibiotics and 50% of the subgroup without antibiotics respectively. However, the difference between the two groups was not statistically significant (log-rank test, p = 0.110). The Cox regression analysis also displayed no significance over the first three years post-treatment (p = 0.115). Additionally, the study found that deeper peri- implant pockets at baseline significantly predicted the need for future surgical treatment (p = 0.031), highlighting the importance of initial disease severity in treatment outcomes. The study concludes that the adjunctive use of systemic amoxicillin and metronidazole with NST may delay but not statistically reduce or prevent a future surgical need. Although a short-term reduction in clinical inflammatory parameters was evident, the long-term effectiveness in altering the progression of peri-implantitis remains limited.

Minimally invasive treatment for idiopathic chondrolysis of the hip: analysis of forty-one cases.

Idiopathic chondrolysis of the hip is characterized by the loss of the articular cartilage of the hip joint with spectrum ranging from full recovery to fibrous ankylosis. Study assessed outcomes following intra-articular steroid injections, joint manipulation and traction immobilization. Retrospective (2012-2021) review of 41 cases treated for idiopathic chondrolysis of hip, assessed pre-operatively and post-operatively (minimum 2-year follow-up) using Children's Hospital Oakland Hip Evaluation Score (CHOHES), visual analogue scale (VAS) and range of motion measurements. Twenty-five patients (62%) achieved painless mobility, 6 (14%) had hip stiffness without pain and 10 (24%) had painful and stiff hips at final follow-up. They had a mean age of 12.49 ± 2.4years and a mean follow-up duration of 33.15 ± 13.1months. Range of motion improved significantly (p < 0.05). VAS improved to 3.93 ± 1.3 from 7.8 ± 0.7. CHOHES improved from 29.12 ± 9.9 to 56.37 ± 17.6. Intra-articular steroid injection, manipulation and traction immobilization may effectively treat idiopathic chondrolysis of the hip by enhancing patient function and reducing the need for further surgical intervention.

A Case of Tracheobronchopathia Osteochondroplastica Confirmed With a Subglottic Lesion

Tracheobronchopathia osteochondroplastica (TO) is rare idiopathic abnormality with incidence of 0.2%–0.7% from bronchoscopy. TO is characterized by focal or diffuse development of osseous and/or cartilaginous nodule in the submucosa of the trachea and bronchial walls. Most of the cases are asymptomatic, and if present, they can be nonspecific and diverse, such coughing and wheezing. Bronchoscopy and radiographic studies are useful diagnostic tool and conservative therapy is needed for each symptoms. Author reports a case of 49-year-old male who presented with throat discomfort without any significant past medical history. A subglottic nodular lesion with ulceration was identified, and laryngeal microsurgery for biopsy was done to rule out Tb or subglottic malignancy. However, the histopathological findings were indicative of TO, then we consult for bronchoscopy to confirm the diagnosis. Bronchoscopy also revealed consistent findings with TO. The patient is currently under conservative management and observation, without the need for further surgical intervention.

Failure Rate and Early Complications of Thumb Carpometacarpal Joint Replacement-A Multicenter Retrospective Study of Two Modern Implant Designs.

Joint replacement arthroplasty for the treatment of thumb osteoarthritis is gaining popularity as recent studies have demonstrated better pinch and grip strength and faster rehabilitation. Our aim was to identify early complications in modern implant designs using a multicenter study. A total of 381 patients who underwent thumb carpometacarpal replacement surgery in six participating hospitals were enrolled. The complications included were fractures, dislocations, infections, tendon and nerve injuries, and complex regional pain syndrome. Major complications were defined as a failure to implant the prosthesis, revision surgery to remove the implant, and any other need for further surgical intervention. The secondary outcomes were any other complications treated non-surgically and the timing of the complications. Eleven procedures failed, and these patients were treated with trapeziectomies. Twelve other patients required repeat surgical interventions. Minor adverse events occurred in 25.4% of the cases, and transient irritation of the superficial radial nerve and De Quervain tendinopathy were the most prevalent complications. Although this cohort depicted the learning curves of multiple surgeons, our study demonstrated low short-term failure rates. An inability to achieve primary stability of the cup in the trapezium was the leading cause of failure. Dislocations and other major complications with modern implants were very few.

Transperineal anastomotic posterior urethroplasty with bulbocavernosus flap and fibrin sealant in the complicated posterior urethral stricture reconstruction: a retrospective cohort study.

Management of complicated posterior urethral stricture is challenging. Modified transperineal anastomotic urethroplasty (TAU) with bulbocavernosus flap interposition and human fibrin sealant provides another treatment option. The authors aimed to evaluate whether this technique could improve the success rate in the complicated posterior urethral stricture reconstruction in this study. Between 2016 and 2019, 48 patients underwent either conventional or modified TAU. The criteria for success included both the absence of clinical symptoms and no need for further surgical intervention during follow-up. Twelve patients underwent the modified TAU (group A) using bulbocavernosus flap interposition and human fibrin sealant. Thirty-six patients underwent the traditional end-to-end anastomotic urethroplasty (group B). Follow-up was 24.3-57.2 months. The patients in group A had a higher surgery success rate compared to the patients in group B (91.7 vs. 63.9%, P =0.067), with a quasi-significant result. Besides, no postoperative complications were observed in group A, while two individuals in group B had urinary incontinence, but the difference was not significant (0 vs. 5.6%, P =0.404). Based on the preliminary results, modified TAU with bulbocavernosus flap interposition and human fibrin sealant is a safe and feasible technique for complicated posterior urethral stricture reconstruction.

Implementing Nexobrid for Burn Debridement in a Major Italian Burn Center: A Retrospective Review of Patient Outcomes.

This retrospective study examines the implementation of Nexobrid, an enzymatic debriding agent developed from bromelain, for burn debridement in a major Italian burn center. With previous research showing encouraging results for Nexobrid in terms of reducing the need for surgical intervention and faster eschar removal, the current study aims to add to the growing body of evidence regarding its potential benefits and limitations. The patient database was utilized to identify patients who received Nexobrid treatment between October 2019 and June 2023. A retrospective analysis was conducted to gather demographic information, burn causes, procedural details, and patient outcomes. Of the 30 patients treated with Nexobrid, 10% did not require further surgical intervention, showcasing Nexobrid's potential to improve patient outcomes. However, over 80% of patients still required additional surgical intervention, demonstrating that Nexobrid's effectiveness varies across patients and should be considered a tool rather than a definitive solution in burn wound management. A few patients developed complications, and about 10% of patients succumbed to systemic complications. The study results reveal both the potential benefits and limitations of using Nexobrid in burn debridement. While it successfully eliminated the need for further surgical intervention in a small percentage of patients, the majority still required additional surgical procedures. These findings not only highlight Nexobrid's role as a tool in burn wound management but also point toward the discrepancies with previous studies. The authors suggest future research should include randomized controlled trials, direct comparisons between Nexobrid and traditional debridement methods, and studies incorporating larger and more diverse patient groups.

Standardized Protocol for Chest Tube Management for Trauma Patients Significantly Decreases Complications.

As health care shifts to a value-based model with a focus on patient outcomes per dollar spent, it is important to develop and evaluate standardized protocols that ultimately lead to improved patient outcomes and decreased hospital complications. Prior to our chest tube protocol, chest tube management at our Trauma Center was nonuniform and surgeon-specific. The aim of this study was to (1) develop an institutional standardized protocol for chest tube management at our Level II Trauma Center and (2) compare patient outcomes before and after the implementation of our protocol. An institutional, standardized protocol was initiated at our Level II-Certified Trauma Center teaching hospital in 2014. An IRB-approved, single-institution retrospective chart review was performed between January 2011 and May 2017, in order to capture the 3 years prior and 3 years after protocol implementation. All patients with a diagnosis of hemothorax or pneumothorax (H/PTX) from blunt or penetrating trauma that resulted in a >24 French chest tube placement were included in the study. Patients were excluded if interventional radiology (IR) placed the chest tube, the mechanism was nontraumatic, or the patient expired at index hospitalization. Univariate analyses were performed to evaluate significant differences in patient outcomes before and after the implementation of the protocol. A total of 143 patients were analyzed for this study, with 43 preprotocol patients and 100 postprotocol patients. Hospital length of stay (LOS), persistent H/PTX, and the need for further surgical intervention all improved after the implementation of the standardized protocol (p < 0.04). Our standardized protocol for chest tube management at our Level II Trauma Center significantly improved patient outcomes and can serve as a model for similar institutions.

Multi-disciplinary management of type 1 and 2 skin tears using a silver-based hydrofiber dressing.

Skin tear is a common problem encountered in the emergency department. If it is not properly managed, it can lead to wound infection, skin necrosis and a need for further surgical intervention and skin grafting. Current management is to cleanse the wound, replace the thin skin tear followed by coverage with a dressing that is inducive for wound healing. Several dressings have been suggested for the coverage of these wounds. But, up to now, there has been no mention of the use of a silver-based hydrofiber dressing in the management of this condition. The objective of this study was to explore the use of a silver-based hydrofiber dressing for the management of paper-thin skin tears. We retrospectively reviewed all patients with Type 1 or 2 skin tears that had undergone management using a silver-based hydrofiber dressing between October 2019 and October 2020. Demographic data and medical history was obtained by retrospective chart review. Data that was collected included: age, sex, comorbid illnesses, defect location, defect size, complications, number of times the silver-based hydrofiber dressing was replaced and the number of days required to achieve complete wound healing. A total of 65 patients were included in the study. There were 42 males and 23 females. There were 28 patients whose age was greater then 85 years old, of which 14 patients were over 90 years old. The mean number of outpatient visits was 2. The mean defect size was 33 cm2 (range 1 cm × 1 cm to 18 × 10 cm). The mean number of days required for total wound healing was 13 days (range 7-21). We did not encounter any patients that required further surgical debridement or split-thickness skin grafting. The use of a silver-based hydrofiber dressing was well tolerated by the elderly population as it provided an easy, efficient, economical and effective form of management of skin tears. We suggest that a silver-based hydrofiber dressing can be used as a first-line treatment method for type 1 and 2 skin tears.

Speech and Burden of Secondary Surgical Interventions Following One-Stage Repair of Unilateral Cleft Lip and Palate and Alveolar Bone Grafting Performed at Different Timings.

A comprehensive assessment of the treatment outcome in cleft lip and palate involves evaluating speech and the impact of speech-correcting surgical interventions. This retrospective case-control study compared the speech outcomes of 37 boys and 19 girls with unilateral cleft lip and palate (UCLP) who underwent one-stage cleft repair at an average age of 8.1 months and alveolar bone grafting either before or after 6 years of age, with a non-cleft control group at an average age of 10 years. Two experienced speech and language pathologists conducted perceptual speech assessments using a specialized test of 27 sentences designed for Polish-speaking cleft patients. The results revealed that 5.3% had severe hypernasality, 1.8% had severely impaired speech intelligibility, 10.7% exhibited retracted compensatory articulations, and 7.1% displayed facial grimacing. Mild hyponasality was observed in 12.3% of patients, while 16.1% exhibited voice abnormalities. Additionally, 12.5% of patients required orofacial fistula repairs, 3.6% underwent pharyngoplasties, and 28.6% received ear ventilation tube insertions. The study indicates that speech abnormalities in UCLP patients were relatively infrequent and not highly severe, suggesting that the primary UCLP repair method presented effectively reduced the need for further surgical interventions, leading to positive speech outcomes.

The impact of COVID-19 on head and neck cancer patients: A review of speech valve complications and patient experience during the COVID-19 pandemic in the United Kingdom

Purpose Surgical voice restoration (SVR) is associated with improved patient quality of life following laryngectomy. This study aims to determine the impact of the COVID-19 pandemic on patients with SVR and analyse the complications in this cohort of patients. Method A retrospective review of all patients with SVR at a single tertiary ear, nose, and throat (ENT) unit in the UK for 12 months during the COVID-19 pandemic, with comparison to the preceding 12 months. A survey was also administered to assess patients’ experiences during the pandemic. Result Thirty-six patients were included in this study. During the pandemic period, 19.5% (n = 7) patients had significant complications, with five patients needing surgery to restore speech. In the 12 months pre-pandemic, 13.5% (n = 5) had significant complications, although none required surgery to restore speech. Six patients (19.4%) felt these complications were avoidable in normal circumstances. Further, 30.5% (n = 11) of patients reported a delay in seeking medical attention due to concerns about their vulnerability to COVID-19. Conclusion The COVID-19 pandemic has had an impact on many patients with SVR. This has resulted in a large proportion of patients experiencing delayed care, a loss of voice, a need for further surgical intervention, and negative impacts on their quality of life.

Factors Associated With Upstaging of Melanoma Thickness on Final Excision

IntroductionThe incidence and risk factors associated with upstaging from initial biopsy to definitive excision in cutaneous melanoma have not been established. The aim of this study was to determine the incidence of tumor stage upstaging and associated risk factors using the National Cancer Database. MethodsA retrospective study of the National Cancer Database between 2012 and 2016 was performed. The cohort of patients undergoing excision of melanoma with available data comprised 133,592 patients. Differences in characteristics for upstaging were determined using Wilcox rank-sum, chi-square, or Fisher's exact tests. Multivariable analysis was performed using logistic regression to determine factors associated with upstaging. ResultsIncidence of upstaging was 5.2%. Upstaged patients were older, male, of non-White race, and of lower education level (P < 0.001). Lesions of the head/neck and lower extremity had increased incidence of upstaging compared to the trunk (P < 0.001). Nodular and acral lentiginous melanoma was associated with higher incidence of upstaging compared to superficial spreading melanoma (P < 0.001). Patients with lymphovascular invasion had increased risk of upstaging (P < 0.001). ConclusionsUpstaging of melanoma is infrequent but is significantly more prevalent in non-White patients and those with lower educational status. Provider and patient education should include the higher risk of upstaging in these groups and the possible need for further surgical intervention, such as re-excision of margins and sentinel lymph node biopsy.

Factors of transurethral incision effectiveness for ureteroceles in pediatric patients: A 28-year, single-institution retrospective review

As a congenital anomaly, ureteroceles occur in 1 in 4000 children, and are usually diagnosed prenatally. However, there remains a lack of definite consensus on the optimal management of congenital ureteroceles. We evaluated factors associated with success of primary transurethral incision (TUI) in ureterocele pediatric patients. Demographic and clinical information for 120 pediatric patients who were diagnosed with congenital ureterocele between 1993 and 2021at our institution were obtained through retrospective chart review. Data were analyzed using Fisher's exact tests, t-tests, and logistic regression with a significance threshold of p<0.05. The primary outcome of ureterocele management was TUI effectiveness, defined by no need for further surgical intervention. Of the 120 patients (39 boys, 81 girls) with ureteroceles, 75 patients (22 boys, 53 girls) met our inclusion criteria of undergoing initial TUI ureterocele. Initial TUI was effective in 51/75 patients (68.0%). We analyzed possible correlative factors for TUI efficacy. Simplex system was a significant predictor of primary TUI efficacy (85% effective in simplex systems, 62% in duplex systems). Prior urinary tract infection, prenatal diagnosis, and electrocautery technique were all associated with an increased risk of needing additional surgeries after primary TUI. The most significant predictors of effective primary TUI were simplex system and the absence of preoperative vesicoureteral reflux. Prenatal diagnosis, preoperative febrile urinary tract infection, higher preoperative hydronephrosis grade, and the use of electrocautery were all associated with decreased primary TUI efficacy. Study limitations include that it was a retrospective chart review, and cohort size was limited by incomplete urology follow-up and operative records. Initial TUI was an effective procedure for the majority of our pediatric ureterocele patients, a higher success rate compared to other cohorts. Patients with a simplex system were more likely to have an effective first TUI than patients with duplex systems, as were patients without preoperative reflux. Although not statistically significant, our data suggest prior UTI, prenatal diagnosis, higher preoperative hydronephrosis grade, and the use of electrocautery may be associated with having additional surgeries.

ROLE OF INNOVATIVE BALLOON TAMPONADE IN ATONIC POST PARTUM HAEMORRHAGE

Introduction: Postpartum hemorrhage is the major cause of maternal deaths, especially in the developing world. Uterine atony is the most common cause of PPH and when the hemorrhage is not controlled with medical management then Intrauterine balloon tamponade is one method that proves very effective and reduces the need for further surgical interventions. T Aims &amp; Objectives: o evaluate the effectiveness of balloon tamponade in the management of atonic PPH. This prospective study was conducte Materials &amp; Methods: d in the Department of Obstetrics &amp; Gynaecology at Government Medical College and Rajendra Hospital, Patiala. We included 50 cases of atonic PPH in the study where medical management failed. Uterine tamponade was achieved by an innovative condom balloon catheter The success rate of balloon tamponade Results: in controlling bleeding came out to be 94%. We concluded that Uterine balloon tam Conclusions: ponade is effective, non-invasive, simple to use, easily available, and cost-effective method for the management of PPH. If we are unable to control bleeding with this method, it provides a temporary tamponade effect to gain time for surgical procedures or referral to a higher center if facilities are not available

The Influence of Endodontic Lesions on The Clinical Evolution of Odontogenic Sinusitis-A Cohort Study.

Endodontic disease with formation of periapical lesions (PALs) is one of the most common causes of chronic odontogenic sinusitis (ODS). It requires close collaboration between otolaryngologists and dentists, but the best sequence of management is still unknown. The aim of the present study is to clarify how radiological characteristics of teeth with PALs and previous root-canal treatment (RCT) influence the clinical evolution of the disease and to define the predictive value of its radiological and endoscopic features in determining the need for further surgical intervention. A total of 68 symptomatic patients with ODS with PALs were included in the study. The evaluation was performed by an otolaryngologist and a dentist based on a medical interview, nasal endoscopy, cold pulp testing and tomography images. Patients were prospectively followed for at least 12 months, during which nasal steroids, saline irrigations and RCT were administered. The criteria of disease improvement were: decrease of symptoms, healed sinonasal mucosa in endoscopy and radiological resolution of periapical radiolucency and sinus inflammation. Results showed that 9 (13%) patients improved after conservative treatment and 59 (87%) required further surgical intervention. Patients who improved after medical treatment and RCT were younger (p = 0.043) and had a greater distance from the top of the periapical lesion to the maxillary sinus' floor (p = 0.003). When expansion of PALs and bone destruction toward the maxillary sinus was observed on radiological imaging (p = 0.041), and when more than one tooth root was affected (p = 0.004), patients were more likely to require surgical intervention. In conclusion, the more roots that are affected and the closer the top of the PAL is to the maxillary sinus' floor, the greater the possibility of medical treatment and RCT failure. When the bone destruction extends into the maxillary sinus, patients eventually require both tooth extraction and FESS in order to resolve ODS completely.

An Alternative Method of Phacoemulsification Surgery in Eyes with Functional Trabeculectomies

Aims: To report success proportions in functional trabeculectomised eyes undergoing phaco-emulsifcation with a novel curvilinear capsulorhexis method. Methods: An observational series. Seventy two eyes of 72 patients were identified who underwent cataract surgery in eyes with functional prior trabeculectomy surgery using a Leweke cannula (cases). A previously reported group of 53 eyes in 53 patient who had routine cataract surgery (not using this technique) post-trabeculectomy surgery was used to compare outcomes (controls). Main outcome measure: The primary outcome measure was intraocular pressure (IOP) success (IOP ≤21, ≤18, ≤15 mmHg) at 5 years post cataract surgery. Complete success was no new medication or surgical intervention for IOP and partial success was additional medical therapy required to achieve the IOP target. Results: At final follow-up, the overall failure proportion of the combined groups for an IOP ≤21mmHg was 20% (24/125) at final review. Thirty percent who were a partial success prior to cataract surgery, failed in both controls and cases at final follow-up. Of those who were a complete success prior to phaco-emulsification; 33% were partial successes and 30% failed in the control group; 50% were partial successes and 10% failed in the case group, at final follow-up. Logistic regression for an outcome of failure showed the Leweke cannula to be protective OR 0.28 (95% CI 0.09 to 0.85, p=0.03). African/Caribbean ethnicity was a risk factor for failure. Conclusions: Our results suggest that cataract surgery may affect trabeculectomy outcomes, but not as profoundly as is currently perceived. Using the Leweke technique seems to result in earlier medication recommencement, but a strong reduction in the need for further surgical intervention in fully functional trabeculectomies.

Virtual Reality combined with Robotic facilitated movements for pain management and sensory stimulation of the upper limb following a Brachial Plexus injury: A case study.

Brachial Plexus injuries are complex in nature caused in large by high impact traffic accidents which can lead to additional complications such as Complex Regional Pain Syndrome and even lead to amputation or the need for further surgical intervention. Treatment options to help repair the brachial plexus initially involve surgical intervention and post-surgery rehabilitation with medication to help with ongoing pain. Pain treatments used for these types of injuries are limited and differ in effectiveness. Paradigms utilising multimodal systems such as the one described in this paper based on virtual reality and robotics could yield results that are non-invasive and provide better rehabilitation outcomes for the sufferers. In this paper we present a single case study exploring whether Virtual Reality plus Haptic feedback have any practical potential for reducing upper limb pain and improving function in patients with brachial plexus injuries. The case study is presented with long standing complex combination of phantom limb and neuropathic pain. A decrease in perceived levels of pain was reported which amounts to a 50% reduction in pain from baseline and an improved range of motion. An examination of the sensory phantom map on the stump seems to indicate an early establishment of the thumb representation on the stump close to the area being stimulated with potential implications for prosthesis use.

Clinical Trial Combining Botulinum Toxin A Injection and Fissurectomy for Chronic Anal Fissure: A Dose-Dependent Study

Abstract Background Anal fissure is a common surgical disease that is usually treated conservatively. The golden surgical treatment for anal fissure is lateral internal sphincterotomy, but it may result in multiple complications. Therefore, other treatment methods have recently been introduced, and one of them is the injection of botulinum toxin A (BTA) and fissurectomy. In the present study, we aim to evaluate the effectiveness of the combination of fissurectomy and BTA injection in the treatment of chronic anal fissure by single surgeon. Materials and Methods The present is a non-randomized prospective cohort study conducted by a single surgeon in Saudi Arabia. Our sample was composed of 116 female patients, with mean age of 36.57 ± 11.52 years, who presented to our Surgical Outpatient Clinic with chronic anal fissure between October 2015 and July 2020, and were treated with BTA injection combined with fissurectomy. They were followed up for 1, 2, 3, 4, and 8 weeks, and after one year to evaluate the efficacy and safety of the treatment. The main outcomes analyzed were symptomatic relief, complications, recurrence, and the need for further surgical intervention. Results The treatment with BTA injection combined with fissurectomy was effective and safe in 115 patients (99.1%) at 1 year of follow-up. A total of 5 patients experienced recurrence at 8 weeks, which resolved completely with pharmacological sphincterotomy, and 12 patients experienced minor incontinence, which disappeared later. Conclusion In total, 70 units of BTA injection combined with fissurectomy is a suitable second-line treatment of choice for chronic anal fissure, with a high degree of success and a low rate of major morbidity.

Nonoperative Management of Humerus Fractures in Patients With Ispilateral Hemiparesis or Hemiplegia.

Patients with upper limb dysfunction from a brain injury often have different goals of treatment and expectations following a fracture of the upper extremity. This study retrospectively reviewed outcomes of nonoperative management of acute humerus fractures in patients with severe ipsilateral hemiparesis or hemiplegia. Patients who had sustained an acute humerus fracture managed nonoperatively, greater than 1 year following an upper motor neuron (UMN) injury resulting in ipsilateral severe hemiparesis or hemiplegia at a single tertiary care center from 1988 to 2019, were reviewed. Fractures were classified using the AO-Müller/Orthopaedic Trauma Association and/or Neer classifications. Primary outcome measures included House classification level of function, pain, achievement of and time to radiographic union, and the need for subsequent surgical procedures. Ten distinct nonoperatively managed humerus fractures-3 proximal (11A23), 5 mid-shaft (12A2b = 1, 12A2c = 2, 12A3a = 1, 12A2b = 1), and 2 distal (13A2 = 1, 13 C1 = 1)-were identified in 8 patients (6 women and 2 men) with ipsilateral hemiparesis or hemiplegia. The median radiographic follow-up was 20 months (range: 78 days to 12 years). The median clinical follow-up was 33.5 months (range: 100 days to 12 years). All patients presented with severe pain that was absent at final follow-up. Radiographic union was achieved in all patients with a mean time to union of 90.9 ± 39.3 days (range: 35-185 days). No patients required operative management. Nonoperative management of humerus fractures in patients with an ipsilateral UMN injury might result in reliable pain relief and union without the need for further surgical intervention. Management of humerus fractures in this patient population should be individualized toward their goals of care.

Controlling Post-Partum Hemorrhage Using A Novel Technique of Multiple Sponge-Holding-Forceps Applied Along Cervical Canal

Introduction: Postpartum hemorrhage (PPH) is not only one of the leading causes of maternal mortality but also the most feared complication amongst obstetricians. Despite various predictive factors, PPH can occur in low risk pregnancies without predictive factors. Application of sponge holding forceps vaginally can invariably stop bleeding, leading to prevention of serious consequences.&#x0D; Aims &amp; Objectives: To determine the proportion of success of PPH control using sponge holders applied vaginally to the cervix after failure of medical treatment and before going for hysterectomy, in immediate post partum period.&#x0D; Place and duration of study: This study was a cross-sectional study conducted at the labour room, Indus Hospital Raiwind for duration of one year from June 2020 to June 2021.&#x0D; Material &amp; Methods: Clinical and demographic features were recorded on a pre-designed proforma. Parity and gravidity was determined. Amount of bleeding was estimated and recorded. Additionally, the final result of patients was reported, as well as if they required surgical intervention. Data was analyzed using SPSS 24.p value ?0.05 was considered significant.&#x0D; Results: The mean (SD) age in our study was 26.28 (4.11) years. In this study majority of the patients were primipara 65% (n=26) and 35% (n=14) were multipara. On the basis of gravidity, more patients 37.5% (n=15) were primigravida while multigravida and grand multigravida patients were 27.5% (n=11) and 35% (n=14) respectively. The mean (SD) blood loss before the procedure was 720 (200) ml while after the procedure it was 90 (130) ml (p=0.02). This procedure was successful in all the patients and there was no need of further surgical intervention.&#x0D; Conclusion: Our study concludes that use of sponge holding forceps as cervical clamp around cervix is one of the effective, economic and safe procedure for PPH patients.

CHARACTERISTICS AND PROCEDURAL OUTCOMES IN PATIENTS WITH PROLONGED AIR-LEAK UNDERGOING ENDOBRONCHIAL VALVES PLACEMENT (EBV): A RETROSPECTIVE CASE SERIES

TOPIC: Disorders of the Pleura TYPE: Original Investigations PURPOSE: Endobronchial valves (EBV)are FDA approved for bronchoscopic lung volume reduction in certain COPD patients. EBV has also emerged as a therapeutic option for patients with pneumothorax (PTX) and persistent air leak. Limited data is available about the characteristics of this patient population and their procedural outcomes. METHODS: We retrospectively reviewed all patients who underwent EBV placement for pneumothorax with prolonged airleak at a tertiary referral center over a 5-year period. Outcomes assessed included length of stay (LOS), need for repeated procedure or further surgical intervention, and resolution of airleak at discharge. RESULTS: Between 2015 and 2020, 36 patients underwent evaluation for EBV for PTX. Secondary spontaneous pneumothorax (SSP) was the primary diagnoses in 25/36 (70%) with COPD as the primary underlying lung disease in 20/25 (80%). Only 30% of patients had VATS with or without resection prior to EBV placement. Median LOS was 25 days with a median of 12 days from pneumothorax onset to EBV placement and 13.5 days between EBV placement and discharge. Early placement of EBV was significantly associated with shorter LOS (R2=0.68; p<0.001). A second bronchoscopy procedure was required during the same admission in 15/36 (41%) for either recurrence or continued air-leak with additional (28%) or replacing (17%) previously placed EBV. Primary Spontanous Pneumothorax (PSP) patients were the least likely to need repeat EBV procedures as compared to patient with SSP [0/4 (0%) vs. 13/25 (52%) respectively; p= 0.05]. Prior lobectomy (p=0.02), older age (p=0.03) and laterality of PTX were more likely to have a second procedure (left greater than right sided PTX (9/11 9 (81%) vs. 6/25 (24%); p=0.001). Median number of EBV placed was 3. Post lobectomy patients had a higher number of total valves compared to other patients (4.5 vs. 3.0 respectively; p=0.03), but none of those patients required an additional surgical intervention. Neither total number valves nor number of lobes targeted affected LOS, need for 2nd procedure, or the need for further surgical intervention after EBV placement. Following EBV, 25/36 patients (70%) had resolution of their airleak without subsequent surgical intervention, 7/36 (20%) required surgical intervention for persistent airleak post EBV placement and 5/36 (14%) patients were discharged with chest tube in place due to persistent airleak. CONCLUSIONS: EBV were effective in stopping airleak in the majority of patients with pneumothorax and persistent airleak. Early placement of EBV significantly correlated with shorter LOS. Further studies are needed to identify patient population who are at risk and would benefit the most from early EBV placement. CLINICAL IMPLICATIONS: EBV can effictively stop airleak and potentially reduce hospital length of stay in patients with pneumothorax and prolonged airleak. DISCLOSURES: No relevant relationships by Mamoon Al Ahmad, source=Web Response No relevant relationships by Yaser Dawod, source=Web Response No relevant relationships by Syed Nazeer Mahmood, source=Web Response No relevant relationships by Jessica Wang Memoli, source=Web Response