Neurological Complications In Group Research Articles

Karotis Arter Stenozunda Cerrahi Endarterektomi ile Endovasküler Stent İmplantasyonunun Orta ve Geç Dönemde Morbidite ve Mortalite Sonuçlarının Karşılaştırılması

Objective: Carotid artery stenosis is an important etiological cause of cerebrovascular events and stent implantation is widely used as an alternative treatment to endarterectomy. In this study, we compared the mid and late-term results of carotid artery stenosis patients who underwent endarterectomy and stent implantation. Methods: Patients who underwent endarterectomy (Group A, n: 27) and endovascular stent implantation (Group B, n: 22) due to carotid artery stenosis between 2008 and 2014 were included in the study. All examination, laboratory data and radiological images were collected from the hospital database. Morbidity and mortality developed in the mid (1-12 months) and late term (>12 months) periods were evaluated retrospectively. Results: While there were no neurological complications and restenosis in the midterm in Group A, 2 patients (9.09%) had stroke and 2 patients (9.09%) had restenosis in Group B. In the late-term, while there were no neurological complications in Group A, stroke in 3 patients (13.63%) (p=0.048) in Group B, restenosis was observed in 1 patient in Group A and 5 patients in Group B (3.7% vs 22.72%, p=0.043). Conclusion: We recommend endarterectomy as the primary approach for carotid artery revascularization and percutaneous approach especially in high-risk patients with recurrent ICA stenosis and distal carotid artery lesions.

Compare of Anterior Approaches in Acetabular Fractures Treated by the Standard Ilioinguinal Versus the Stoppa/Iliac Approaches

Background. In acetabular fractures, the correct choice of the surgical approach is mandatory to achieve accurate reduction and to avoid complications. Anterior approaches include the ilioinguinal, the Stoppa, the iliofemoral and the pararectal exposures. The ilioinguinal and the Stoppa approaches are the most ones nowadays. The purpose of the study was to compare the efficacy of modified Stoppa and ilioinguinal approach in the management of acetabular fractures in terms of quality of reduction achieved, complication rates, functional outcomes, operative time, intraoperative blood loss, view angle of the surgical wound, the applicability of the forceps. Materials and Methods. The study enrolled 53 adult patients. We evaluated 53 cases of treatment of patients underwent acetabular fractures osteosynthesis. The patients were divided into two groups. We used the Letournel approach in group 1 (n = 27), the Stoppa/iliac approach — in group 2 (n = 26). The group 2 was split into two subgroups: in subgroup 2A, osteotomy of the anterior superior spine was performed (n = 13), in subgroup 2B, we did not perform it (n = 13). The following parameters were compared: the quality of reposition of fragments, operation time, intraoperative blood loss, damage to neural structures, viewing angle, and ease of use of pelvic instruments for reduction. The functional outcome was assessed by the Majeed scale. Results. Comparison of the two approaches showed that the indices of reduction of fragments, total blood loss and operation time did not differ significantly and were not statistically significant (p0.05). However, there were more neurological complications in group 1, but they did not affect the treatment outcome. The angle of the sector of view during the operation with osteotomy of the anterior superior spine of the pelvic wing is about 90°, which contributes to a more efficient use of repositioning instruments. The functional results of treatment were the same in both groups in 12 months after surgery. Conclusion. The Letournel and the Stoppa/iliac approach are equivalent in terms of the degree of reduction, operation time and blood loss during the operation. Application the Stoppa/iliac approach helps to avoid iatrogenic meralgia paresthetica unlike Letournel approach. The Stoppa/iliac approach and osteotomy of the anterior superior spine provides better visualization and provides a greater degree of freedom for the surgeon during manipulation tools for reposition.

RESULTS OF THE ARC AND ASCENDING AORTA PROSTHETIC REPLACEMENT UNDER DIFFERENT BRAIN PROTECTION CONDITIONS

Aim . To evaluate the results of prosthetic replacement of ascending aorta and the arc, according to the methods of brain protection. Material and methods . Totally, 63 patients included, 52 (42-60) year old with DeBakey type I chronic dissection. Group 1 (n=32) — with the method of antegrade brain perfusion (AP) within artificial circulation (AC) and hypothermia (23-24º C); group 2 (n=31) with retrograde perfusion (RP) within AC and profound hypothermia (18º C). With the cerebral oxymetry the frontal lobe oxygen supply was measured (rSO2, %) during the operation. Questionnaire SF-36 was in use for life quality assessment before and late after operation. Results. In the group 1 the rSO2 during AC reduced less than 10% from baseline, and in the group 2 values of rSO2 reduced by more than 30%, (p<0,05). Neurological complications in group 1 were registered in 12,5% cases, in the group 2 — in 35,4% (p<0,05). Logistic regression showed that decrease of rSO2 during AC for more than 33% from baseline does raise the odds for neurological disorders development 5 times. Mental health parameter (MH) in long-term follow-up of operation was negatively correlated with the duration of AC (r=-0,46; p=0,003). Conclusion. Antegrade perfusion of the brain under conditions of moderate hypothermia during reconstruction surgery of proxymal aorta demonstrated better cerebroprotection, which was showed by lower rate of neurological complications in early post-operation period comparing to patients after systemic hypothermic AC.

Comparison of Subtransverse Process Wiring and Sublaminar Wiring in the Treatment of Idiopathic Thoracic Scoliosis

A retrospective study. The objectives of this study were to show the advantages of an alternative segmental spinal instrumentation technique, termed subtransverse process wiring, and compare it with a sublaminar wiring technique in the treatment of idiopathic thoracic scoliosis. High rates of neurological complications and the need for high experience limit the use of the sublaminar wiring technique, although it is an effective segmental spinal instrumentation technique in the treatment of scoliosis. This is the first study to correlate sublaminar wiring and subtransverse process wiring techniques clinically. In a retrospective study, 64 patients with idiopathic thoracic scoliosis were chosen randomly. Nineteen patients were treated with subtransverse process wires (group A), and 45 patients were treated with sublaminar wires (group B). The mean follow-up period was 50.9 months (25 to 90 mo) in group A and 57.9 months (26 to 108 mo) in group B. The average deformity correction was 26.5 degrees (52.9%) in group A and 28.9 degrees (54.1%) in group B. The average correction loss was 2.9 degrees (17.2%) in group A and 6.4 degrees (27%) in group B. None of the patients developed neurological complications in group A. In group B, 5 (11.1%) intraoperative dural tears, 4 (8.9%) neurological deficits, and 8 (14.4%) transient dysesthesia syndromes were seen. The average operation time was 3.6 hours (3 to 4 h) in group A and 4.9 hours (3.75 to 8 h) in group B. The average replacement of blood (erythrocyte suspension) was 2.9 U (2 to 5 U) in group A and 3.1 U (2 to 6 U) in group B. Sublaminar wiring is a time-consuming technique with high risks of neurological complications, whereas subtransverse process wiring is an easy and neurologically safe method, which maintains effective deformity correction and stability of the correction.

Perfusão cerebral retrógrada é método eficaz de proteção cerebral?: resultados imediatos de estudo consecutivo e randomizado

Foram estudados 30 pacientes com diagnóstico de aneurisma ou dissecção de aorta tratados cirurgicamente. O método utilizado consistiu: uso de hipotermia profunda, parada circulatória total, infusão de 0,20 mg/Kg de peso de dexametasona intravenosa e 10 mg/Kg/peso de thiopental, colocação dos pacientes em Trendelemburg a 45 graus durante o período de parada respiratória. Os 30 pacientes foram operados consecutivamente e randomizados em 2 grupos. Grupo I constituído de 15 pacientes, nos quais foi utilizada a perfusão cerebral retrógrada (PCR) através da veia cava superior e Grupo II também com 15 pacientes nos quais não foi utilizada PCR. Onze (36,7%) pacientes tinham aneurisma da aorta ascendente e arco aórtico, 7 (23,3%) tinham dissecção aguda da aorta do tipo I, 6 (20%) com dissecção crônica da aorta ascendente e os 6 (20%) restantes outros diagnósticos não agrupáveis. Foi realizada análise das seguintes variáveis independentes para mortalidade: idade, sexo, tempo de circulação extracorpórea, tempo de parada circulatória, diagnóstico, complicações prévias, comparando os dois grupos. A mortalidade imediata do Grupo I foi de 4/15 (insuficiência respiratória) 26,6% e no Grupo II 3/15 (coma) 20,0% - p =1,00. A incidência de complicações neurológicas no Grupo I foi 3/15 (20,0%) e no Grupo II, 2/15 (13,3%) p = 1,000. A análise estatística utilizando o teste exato de Fisher não demonstrou diferença entre os dois grupos com relação à mortalidade imediata e complicações neurológicas. As causas de óbito foram: insuficiência respiratória em 4 pacientes, alteração neurológica, hiperpotassemia e infarto do miocárdio, respectivamente nos 3 últimos. No presente trabalho, concluímos que a associação de PCR não oferece proteção cerebral mais eficaz que a parada circulatória total associada à hipotermia profunda, para o tempo de isquemia utilizado.

Open wedge high tibial osteotomy using fractioned drill osteotomy: a surgical modification that lowers the complication rate.

We investigated retrospectively 132 cases of open wedge high tibial osteotomy using an external fixation device, concentrating on the rate of neurological complications. One group of patients underwent surgery according to the conventional technique (n = 89). The rate of transient neurological complications was 15.7%; 7 months after surgery the rate of persistent deficits was 12.4%. For the second group (n = 43) a modified surgical technique was used that lowered the complication rate significantly (transient deficits 14%, persistent deficits 4.7%). In the modified technique the osteotomy is not performed in the conventional way using an oscillating saw but through consecutive drill holes of increasing diameter followed by osteoclasis. The lower complication rate in the second group is mainly due to the less extensive approach that leads to a smaller number of postoperative tibialis anterior syndromes (type B lesion). No differences were found with type C lesions (extension deficit of D1). No complete peroneal nerve palsy (type A) occurred in either group. We conclude that the reduction of neurological complications in group 2 is related to the less extensive approach of the proposed technique.