Postoperative Period Research Articles

The efficacy of patellar denervation on prognosis and kneeling capacity after unicompartmental knee arthroplasty: a randomized clinical trial.

The aim of this study was to investigate the effect of patellar denervation (PD) on pain, function and ability to kneel after unicompartmental knee arthroplasty (UKA). Patients with medial knee osteoarthritis who underwent UKA were prospectively selected. Patients were randomly divided into PD and non-PD groups based on whether patellar denervation was performed. Clinical assessment was performed using the Hospital for Special Surgery (HSS) knee score, Kujiala score, visual analogue scale (VAS) and forgotten joint score (FJS-12), as well as postoperative complications were recorded. The patients' postoperative self-perception and actual ability to perform different kneeling positions were assessed in the two groups. UKA patients treated with PD achieved better Kujiala scores and FJS-12 scores, reduced anterior knee pain and improved kneeling ability postoperatively, validating the effectiveness of PD in UKA. Perception and actual performance of kneeling remained mismatched in PD patients, but performance during different kneeling activities was generally better than in non-PD patients. Clinical Trial Registration: ChiCTR1900025669. Patellar denervation can safely and effectively improve patellofemoral joint function, pain and kneeling ability in the early postoperative period after UKA.

Endometriosis-Associated Infertility: The Role of Biomarkers of Apoptosis and Proliferation in Early Noninvasive Diagnosis

INTRODUCTION: Endometriosis is a common disease that affects up to 15% of women in the reproductive period and leads to infertility in 25%–50% of cases. The diagnosis of endometriosis is delayed for years due to blurred and diverse clinical presentation, therefore, search for a noninvasive biomarker of endometriosis is an important problem of modern medicine. AIM: To study the significance of changes in the profile of biomarkers: regulator of Wnt/β-catenin signaling pathway (axis inhibition protein 1; AXIN-1), soluble cytokeratin 19 fragment (cytokeratin fragment antigen 21-1; CYFRA-21-1), cancer antigen 125 (carbohydrate antigen 125; CA-125) in blood plasma of patients with endometriosis-associated infertility (before surgery and in the postoperative period). MATERIALS AND METHODS: The study included two groups of female patients. The first group consisted of 20 patients of reproductive age with cystic ovarian endometriosis and infertility. All the patients underwent surgical intervention using a laparoscope and a video system, in all the patients the diagnosis of endometriosis was confirmed histologically. Three times in specified periods (before surgery, on the 10th day of the postoperative period, at 6 months), patients with cystic ovarian endometriosis and infertility were taken biomaterial (blood) with further determination of AXIN-1, CYFRA-21-1, CA-125 in blood plasma. The second group consisted of patients of reproductive age with no gynecological pathology. In the second group, biological material (blood) was taken once with further determination of AXIN-1, CYFRA-21-1, CA-125 in blood plasma. RESULTS: Based on the analysis of the measurement data and comparison of their levels, it was found that the content of the studied AXIN-1, СA-125 biomarkers in patients with cystic ovarian endometriosis and infertility was higher than in patients without gynecological pathology (p 0.05). As for CYFRA-21-1 biomarker, initially lower values were noted compared to the control group (p 0.05), however, in the postoperative period, the content of CYFRA-21-1 increased and reached values close to those of healthy patients. CONCLUSION: Determining the levels of AXIN-1, CYFRA-21-1 apoptosis biomarkers and CA-125 proliferation biomarker in blood of patients with endometriosis-associated infertility gives an insight into the pathophysiological processes in the endometrioid ovarian cysts and may be helpful in development of new noninvasive diagnostic methods and target treatment methods.

Radiological and biomechanical evaluation of the ulnar nerve after the percutaneous application of the medial K-wire in the extended position on supracondylar humerus fractures: Does the postoperative long arm splint position matter?

Our study aimed to evaluate and compare the changes in ulnar nerve tension and strain at different elbow positions radiologically and mechanically before and after applying the medial K-wire on the supracondylar humerus fracture cadaver model. We used ten fresh frozen cadaver upper extremity specimens to measure strain and tension on the ulnar nerve in 3 different elbow positions: elbow full extension, elbow flexion-forearm supination, and elbow flexion-forearm pronation. We employed Shear wave elastography (Siemens Acuson S3000 USG, 9L4 linear probe) and a microstrain gauge (Microstrain, Inc., Burlington) to obtain our measurements. Minimum, maximum and mean stress and strain values on the nerve and its surroundings were measured and compared statistically. The mean values of elbows with full extension are statistically lower than those in elbows with 90° flexion-forearm supination and those with 90° flexion-forearm pronation positions. Statistical evaluations were performed between all of the groups. Elbow 90° flexion-forearm pronation, both minimum and maximum and mean values were statistically higher in the group, including the specimens with Kirschner applied. The mean values in the elbow full extension and elbow 90° flexion-forearm supination positions were statistically similar in the specimens with and without the K-wire applied. Despite the numerous techniques described in the literature, there is no absolute technical method to prevent ulnar nerve damage. K-wire application to the medial epicondyle with the elbow in a slightly extended position is a technique that can be applied to reduce the risk of ulnar nerve paralysis. However, it has been reported that ulnar nerve damage can be observed in cases where a splint is placed in the 90° flexion position. We hypothesize that the position of the elbow joint in the postoperative period may contribute to ulnar nerve paralysis due to soft tissue tension and strain and as a result of changing the balance of the surrounding tissues. Our findings suggest that the long arm splint applied in elbow 90° flexion and forearm pronation position should not be preferred in the postoperative period. The maximum strain values obtained in the elbow full extension were lower, suggesting that it would be appropriate to stabilize the elbow in the extension position as much as possible postoperatively. Level of evidence: Level V.

Colonic torsion and volvulus in dogs is associated with a low mortality rate and good long-term outcome.

To describe clinical findings, complications, and short- and long-term outcomes associated with colonic torsion and volvulus in dogs. 28 client-owned dogs. Multi-institutional, retrospective study. Medical records were searched for dogs of any age, body weight, sex, and breed that underwent surgery for colonic torsion and volvulus. Collected data included signalment, previous history, preoperative findings, time until surgery, intraoperative findings, postoperative complications, length of hospitalization, survival to discharge, and outcomes. 28 dogs were included. Thirteen of 28 dogs (46.4%) had preexisting gastrointestinal conditions. Nine of 28 dogs (32.1%) had a gastropexy performed prior to presentation. Ten dogs (35.7%) were found to have a resolution of colonic torsion and volvulus at the time of the surgery. All but 1 dog (27 of 28 [96.4%]) survived to discharge. Two dogs died during the postoperative period, yielding a mortality rate of 7.1%. Postoperative complications were noted in 9 dogs (9 of 28 [32.1%]). Long-term follow-up information was available in 16 of 28 dogs (57%). Among 16 dogs with at least 6 months' follow-up, all dogs (16 of 16 [100%]) were alive at 6 months postoperatively. Two dogs developed mesenteric torsion after the initial surgery. Dogs with colonic torsion and volvulus undergoing surgery can have an excellent survival-to-discharge ratio with a low mortality rate. Surgeons should not be prompted to euthanize or assume a guarded prognosis solely on the basis of the intraoperative appearance of the bowel and should consider all factors prior to making decisions. Owners should be informed of the risk of developing further torsional diseases after surgery.

Choice of Alternative Method of Surgical Intervention in Abdominal Rectus Diastasis with Concomitant Midline Hernias

INTRODUCTION: To date, no consensus has been achieved on the most appropriate surgical method for the treatment of abdominal rectus diastasis concomitant with midline hernias. AIM: Study of the results of three original methods of surgical treatment of patients with abdominal rectus diastasis concomitant with midline hernias. MATERIALS AND METHODS: The results of treatment of 74 patients have been analyzed. The patients were divided into three comparable groups: in the first group (n = 25), repair with local tissues with formation of aponeurotic duplication was performed, in the second group (n = 24), autodermal de-epithelialized graft was used, in the third group (n = 25) — mesh sub-lay implants. The following parameters were evaluated: duration of narcotic analgesia in the postoperative period, period of activation of patients, periods of inpatient treatment and results on Clavien-Dindo and EuraHSQoL scales. The follow-up period was from 1 to 10 years after surgery. RESULTS: The period of postoperative use of narcotic analgesics was 1.08 ± 0.38 days in the first group, 0.98 ± 0.33 days in the second group, 2.13 ± 0.93 days in the third group. The period of activation was 3.00 ± 1.53 days in the first group, 0.89 ± 0.36 days in the second group, 1.5 ± 0.48 days in the third group; the duration of inpatient treatment was 9.24 ± 1.88 bed-days, 6.34 ± 3.04 bed-days and 8.36 ± 2.14 bed-days, respectively. Postoperative complications in the first group were CDI class 6, CDII class 3, in the second group CDI class 1, in the third group CDI class 6, CDII class 3. At 12 months after the operation, painful sensations and functional discomfort on EuraHSQoL scale were absent in the second group, in the first and third groups, limitations in physical activity were noted (р ≤ 0.05; differences between the first and third groups were statistically insignificant, p ≥ 0.05). There were no statistically significant differences in the cosmetic discomfort between the groups (p ≥ 0.05). CONCLUSION: A safer and more effective method of repair of the anterior abdominal wall in patients with concomitant abdominal rectus diastasis and midline hernias is plastic surgery with application of de-epithelialized autodermal graft.

A Case Study of Pan-Facial Trauma with Subsequent Chronic Hyponatremia

Pan-facial trauma represents a complex pattern of injuries requiring meticulous surgical planning and comprehensive post-operative care. We present a case of a 51-year-old male smoker who sustained severe pan-facial trauma. Initial evaluation revealed multiple facial fractures, including the zygomatic maxillary complex, coronoid, condylar, and symphysis regions. Computed tomography demonstrated additional linear undisplaced fractures of the left temporal and parietal bones, with associated hemorrhagic contusion in the right temporal region. The patient exhibited circumorbital edema, ecchymosis, and multiple lacerations over the scalp and face. Laboratory investigations revealed anemia with hemoglobin of 8.7 g/dL. Following initial stabilization, the patient underwent open reduction and internal fixation under general anesthesia. During the post-operative period, the patient developed significant hyponatremia with serum sodium levels dropping to 117 mEq/L, manifesting as altered sensorium and drowsiness. The electrolyte imbalance was managed using a combination therapy of normal saline infusion (500mL at 20mL/hr), 3% hypertonic saline (10mL/hr), and oral tolvaptan (15mg twice daily). This intervention successfully normalized serum sodium levels to 135 mEq/L within three days. This case highlights the importance of vigilant post-operative monitoring in pan-facial trauma patients, particularly for electrolyte disturbances, and demonstrates the effectiveness of prompt, targeted intervention in managing complications. The successful outcome emphasizes the value of a multidisciplinary approach in treating complex maxillofacial injuries

Quick action required: revealing pheochromocytoma as the hidden trigger behind postoperative hypertensive crisis.

Managing patients who present with elevated blood pressure (BP) requires careful but expeditious assessment and triage to differentiate between those at immediate risk of complications and those for whom BP elevation does not pose an immediate threat to health. We present a case of a 54-year-old healthy male patient who experienced refractory hypertension during the immediate postoperative period following nasal surgery. Additional gastrointestinal symptoms and imaging findings made it possible to consider a catecholamine-producing tumour as the primary cause. Despite efforts, managing hypertension continued to be a challenge, and major neurologic complications arose within the following hours. This case illustrates the potential for rapid changes in the clinical scene during hypertensive emergency management. If not addressed promptly, a routine postoperative complication (at first glance) can turn into serious complications, particularly when there are uncommon underlying causes involved.

Projection of visual material on postoperative delirium in patients undergoing cardiac surgery: A double blind randomized clinical trial.

Postoperative delirium is a neurobehavioral disorder that can appear after surgery. It is characterized by an altered level of consciousness and impaired cognitive function. The aim of this study was to evaluate the impact of visual projection of images of relatives or loved ones in patients undergoing cardiac surgery in the immediate postoperative period, and its influence on the incidence and development of postoperative delirium. A randomized, double-blind clinical trial was designed in the immediate postoperative period of adult patients undergoing cardiac surgery. Consolidated Statement of Reporting Trials guidelines were followed. A control group (CG) and an intervention group (IG) were established. In the IG, the patients underwent a visual projection, while the usual unit treatment was carried out with the CG. Sociodemographic, anthropometric, anesthetic, and surgical variables were also recorded. The postoperative delirium assessment scale used was the confusion assessment method for diagnosing delirium in intensive care unit patients. Information was collected from 104 patients undergoing cardiac surgery. Most of the patients included in the study were men (66.35%) and the most performed surgical intervention was aortic valve replacement (34.62%). In the CG, positive patients in postoperative delirium increased from 19.23% to 25%, while in the IG they decreased from 5.77% to 1.92%. The logistic regression analysis presents a prediction model where the variables that influence the model are gender and group membership, meaning that being female and belonging to the IG significantly reduce the presence of delirium. The projection of visual material reduced the incidence of postoperative delirium in patients undergoing cardiac surgery, although it cannot be established that it is effective as a treatment once the pathology is already established.

Outcomes reported in elective colorectal cancer surgery research for older patients: A scoping review.

Colorectal cancer rates are increasing in older populations, who often have comorbidities and face higher surgical risks and mortality rates. Therefore, surgical outcomes, such as 5-year mortality rates, may not be appropriate, necessitating a focus on postoperative quality of life. However, determining optimal postoperative outcome measures for older colorectal cancer patients poses a challenge. This scoping review aimed to explore currently available data describing postoperative outcomes used to assess older patients undergoing elective colorectal cancer surgery. We conducted a comprehensive literature search of major electronic databases from inception to March 2023. Studies exploring frail or older individuals with colorectal cancer undergoing elective surgical procedures, and which reported postoperative outcomes, were included. Outcomes were categorized as surgery-specific versus person-centred and summarized using narrative synthesis. The type and rate of surgery-specific outcomes were tabulated. Of 1366 identified citations, 16 studies focused on person-centred outcomes and 66 reported exclusively on surgery-specific outcomes. Nine 'person-centred outcome' studies reported discharge destination, primarily home discharge. Postoperative delirium ranged from 8.2% to 18.1% in six studies. Four studies explored geriatric syndromes, three analysed activities of daily living, and three studies reported significant quality of life improvement. The 66 'surgery-specific outcome' studies assessed mortality (N = 61); length of stay (N = 40); postoperative complications (N = 47); readmission (N = 18); reoperation (N = 16); and survival (N = 42). Person-centred outcomes are underreported, but crucial for guiding patient management. Older patients require adequate information about their postoperative recovery period to enhance wellbeing. Future research must address this gap to improve care for older people undergoing elective colorectal cancer surgery.

Outcomes of Proximal Hybrid Arterial Reconstruction in Combination with Simultaneous Amputation in Dry Atherosclerotic Gangrene of Toes

INTRODUCTION: When treating atherosclerotic gangrene of the lower limb (LL), the surgeon faces the questions about the reasonability of vascular reconstruction and the optimal timing of amputation after surgery on the LL arteries. The answer to these questions is given by assessing the state of the microvasculature of the operated limb. With sufficient development of the microvasculature and good collateral circulation, it is possible to perform a simultaneous amputation after proximal reconstruction. In this situation, a clear demarcation of the zone of necrosis and reversible ischemia is required, which can be realized by the method of ultraviolet luminescence spectroscopy. AIM: To analyze the results of hybrid reconstructions on the LL arteries with multilevel diffuse atherosclerotic lesions and dry gangrene of toes (DGT). MATERIALS AND METHODS: A prospective, controlled, non-randomized study included 29 patients suffering from critical ischemia of the lower limbs and having DGT, who were operated on in the amount of hybrid arterial reconstruction. The patients were divided into two groups: patients of group 1 (n = 14) underwent restoration of the main blood flow at the level of the iliofemoral arterial segment using a hybrid method, with simultaneous minor amputation of LL at various levels; patients of group 2 (control group, n = 15) underwent a simultaneous proximal and distal hybrid operation, providing main blood flow through at least one of the lower leg arteries, followed by a minor amputation of the lower leg at various levels over the next 4–5 days. RESULTS: There were no statistically significant differences in the groups in the degree of decrease in luminescence intensity after vascular surgery. A histological examination of intraoperative preparations of DGT revealed necrosis of the cellular microenvironment at luminescence amplitude (1.0 ± 0.05) × 105 photons at 410 nm frequency. At luminescence amplitude not exceeding this level, signs of necrobiosis were noted. Luminescence level of ≥ 1.0 × 105 photons was used as the amputation boundary. In the case of an uncomplicated vascular stage of the operation, a comparable decrease in the conventional amputation boundary was noted in the study groups. In the early postoperative period, in patients of group 1, the level of inflammation markers, average number of bed-days, and the number of thrombotic complications were lower than in the control group (p 0.05). A strong correlation was recorded between the morphological signs of the acute phase of inflammation and the intensity of chemiluminescence (r = 0.7, p 0.005). CONCLUSION: In patients with DGT, at a luminescence amplitude on the lower leg and foot not exceeding 1.0 × 105 photons at 410 nm frequency and 0.7 × 105 photons at 450 nm frequency, an effective treatment method is restoration of the main blood flow in the iliofemoral segment using a hybrid method with simultaneous minor amputation at various levels of the foot. This luminescence level is the conventional boundary between necrotic changes and reversible ischemia (necrobiosis) of the soft tissues of the LL.

Impact of high-flow nasal oxygen therapy on postoperative atelectasis and reintubation rate after paediatric cardiac surgery.

Airway problems emerging after congenital cardiac surgery operations may have an impact on mortality and morbidity. Recently, to improve alveolar gas exchange and reduce respiratory effort, high-flow nasal cannula (HFNC) has started to be used in paediatric cases. This study aimed to evaluate the potential effects of high-flow nasal oxygen therapy on postoperative atelectasis development and reintubation rate in paediatric cardiac surgery patients. This study was conducted retrospectively in term newborns and infants younger than six months of age who underwent congenital cardiac surgery operation from 1 November 2022 to 1 November 2023 and were followed in the paediatric cardiac ICU. Patients who were receiving mechanical ventilator support at least 12 hours postoperatively were evaluated for the development of postoperative atelectasis and reintubation in the first 3 days of extubation. The patients were grouped as HFNC and non-HFNC users. Demographic characteristics, surgery type, and ICU clinical follow-up data were obtained from medical records. The results were statistically evaluated. A total of 40 patients who did not use HFNC in the early postoperative period and 40 patients with HFNC in the late period during the study period were included in the study. The median age was 1 month (IQR 15 days-2 months) with equal gender distribution. Among patients, 70% of them were in the neonatal age group. Reintubation rates in the first 72 hours in HFNC users and non-HFNC users were 2.5% and 12.5%, respectively (p < 0.05). The median postoperative atelectasis scores at 24, 48, and 72 hours of extubation were 2 versus 2.5 (p > 0.05), 1.5 versus 3.5 (p < 0.05), and 1 versus 3 (p < 0.05) in HFNC users and non-HFNC users, respectively. HFNC therapy may have a positive effect on preventing atelectasis and reducing the reintubation rate in the early postoperative period.

Use of Branched EVAR in Treatment of Juxtarenal Aortic Aneurysm and Essential Accessory Renal Artery: Another Tool on the Shelf? A Case Report.

We present the case of a 58-year-old male patient referred to our department from a smaller facility for further evaluation and treatment strategy regarding the choice between open or endovascular surgery. The patient was diagnosed with a 6cm asymptomatic juxtarenal aortic aneurysm and a 5mm diameter accessory renal artery (ARA) supplying the lower half of left kidney. Further diagnostic assessments indicated that the left ARA was perfusing over 40% of the left kidney. Given the patient's significant pre-existing medical conditions and elevated perioperative risk, the decision was made to proceed with minimally invasive endovascular surgery using a custom-made 5-branches stent graft (BEVAR). In the early postoperative period, the patient reported left flank pain. A subsequent CT scan identified a partial infarction in the left kidney due to the occlusion of an early small branch from the upper left renal artery. However, laboratory results showed no significant change in renal function compared to preoperative values. The patient was discharged 6 days post-surgery, with no additional complications observed during the early postoperative period. This case report demonstrates that BEVAR is acceptable technique with satisfactory early postoperative outcomes for treating juxtarenal aortic aneurysms with an accessory renal artery in patients who are high-risk candidates for open repair and anatomically unsuitable for FEVAR or Ch-EVAR procedures.

Sustained relief with spinal cord stimulator despite anterior lead migration: a case report.

Lead migration is a common complication of spinal cord stimulation, although anterior migration is rare. While early studies suggested that anterior stimulation may produce analgesic effects, it is thought to be poorly tolerated due to abnormal paresthesia and muscle contractions due to its proximity to the corticospinal tract. This case report presents a unique case of sustained pain relief despite anterior lead migration, which suggests that anterior column stimulation may hold clinical significance for pain management. Further studies are needed to explore its analgesic mechanisms and potential therapeutic application. Strategies to prevent lead migration, particularly in the early postoperative period, are also crucial for optimizing outcomes.

Comparative evaluation of three different behavior management techniques among children aged 6-12 years in dental practice: A single-center, double-blind, randomized controlled trial.

Dental anxiety is characterized by distress in anticipation of dental visits, which may result in a child's refusal to undergo treatment and, ultimately, lead to parents' reluctance towards dental care. The aim of this study was to evaluate and compare the effectiveness of the tell-show-do technique, modeling technique and yogic relaxation technique in the reduction of dental anxiety among children aged 6-12 years. The study was an interventional, parallel-group, single-center, double-blind, randomized controlled trial conducted on 120 children who required restorative treatment without the use of local anesthesia. The participants were selected based on specific inclusion and exclusion criteria and were randomly divided into 3 groups: group 1 - tell-show-do technique; group 2 - modeling technique; group 3 - yogic relaxation technique. The dental anxiety levels were evaluated 4 times using both physiological (oxygen saturation and pulse rate) and behavioral parameters (facial image scale (FIS) and the Face, Legs, Activity, Cry, and Consolability scale (FLACC)). The data was assessed by 2 blinded and calibrated specialists. Statistically significant differences were observed in all 4 parameters among the 3 groups. During both the intraoperative and postoperative periods, the oxygen saturation levels were significantly higher in the yogic relaxation technique group. Moreover, the yogic relaxation technique group exhibited lower pulse rates, FIS and FLACC scores compared to the tell-show-do and modeling technique groups. The practice of yoga has a positive influence on the general health of the individual. Consequently, it can be considered one of the alternative behavioral modification techniques for the reduction of dental anxiety in children.

Surgical Reconstruction in Malignant Eyelid Tumors.

To report the histopathological subtypes of malignant eyelid tumors treated surgically in the author's clinic and to present the author's graft and flap preferences in the reconstruction of the eyelid defect after surgical excision. This retrospective study included 33 patients who underwent malignant eyelid tumor excision, followed by eyelid reconstruction. A frozen section was performed during surgery to assess surgical margins in all patients. Demographic characteristics, histological classification, localization, and size of the tumor, postoperative defect size, follow-up period, complications, and recurrence rate were recorded. Of the patients with a mean age of 66.6 ± 15.3 (range: 23-94), 15 (45.5%) were females and 18 (54.5%) were males. The lower eyelid was the most commonly involved site in 27 (81.8%) patients. Basal cell carcinoma was the most frequently diagnosed type of malignant cancer in 81.8% (n = 27) of the cases. Among the tumor subtypes, nodular type basal cell carcinoma was the most frequently observed subtype in 10 (30.3%) patients. Wide excision with different flap and graft techniques was performed in 26 (78.8%) patients with defect sizes of 40% or larger. In the author's study, the most preferred flap technique for anterior lamella reconstruction was the Tenzel semicircular flap (30.3% n = 10). The most frequently preferred flap for posterior lamella reconstruction was the Hughes tarsoconjunctival flap (30.3% n = 10). There were no flap or graft failures in any of the author's cases. In the treatment of malignant eyelid tumors, different local flap and graft techniques selected according to the size of the defect have successful anatomical results in reconstructive surgery after frozen section controlled excision.

Rates of Early Recovery Following Thumb Carpometacarpal Arthroplasty: Comparing Ligament Reconstruction and Tendon Interposition, Abductor Pollicis Longus Suspensionplasty, and Suture Button Suspensionplasty

Abstract Background Several techniques have been previously described for the treatment of thumb carpometacarpal (CMC) arthritis, including trapeziectomy with ligament reconstruction and tendon interposition (LRTI), abductor pollicis longus suspensionplasty (APLS), or suture button suspensionplasty (SBS). It remains unclear whether a specific method produces faster recovery and more rapid return to function. The purpose of this study was to evaluate early clinical outcomes in patients undergoing thumb CMC arthroplasty stratified by method of treatment. Methods This study was conducted using a registry of patients undergoing thumb CMC arthroplasty using LRTI, APLS, or SBS. Patients were grouped by technique for comparison. Patient-reported outcomes were measured using Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity, Pain Interference, and Pain Intensity scores and compared across cohorts using analysis of variance. Regression analysis was used to determine factors associated with early clinical outcomes. Results Note that 150 out of 201 patients met inclusion criteria for this study. Univariate regression demonstrated no difference between technique and achievement of minimal clinically important difference (MCID) by 1 year or ∆PROMIS scores at 1 and 3 months postoperatively. Stepwise multivariate regression analysis also found that technique did not contribute significantly to postoperative outcomes. Increased baseline PROMIS Upper Extremity scores were associated with lower odds of achieving MCID (odds ratio 0.80, p &lt; 0.001). Baseline PROMIS scores were also associated with ∆PROMIS scores at 1 and 3 months postoperatively. Conclusion Patients undergoing thumb CMC arthroplasty via LRTI, APLS, or SBS can expect to experience similar improvements from baseline in the early postoperative period regardless of technique choice.

Value of Factor V in the diagnosis of early graft dysfunction after liver transplantation: Internal validation.

Primary graft dysfunction is a major early complication following liver transplantation, potentially leading to retransplantation or patient death. Coagulation Factor V (FV) and ALT have emerged as important biomarkers in assessing liver function, yet their role as early predictors of graft loss has not been fully validated. The aim of this study is to conduct an internal validation of published results on the applicability of FV and ALT for diagnosing graft dysfunction and its predictive ability for graft loss within the first 90 days. We conducted a retrospective cohort study including 513 adult recipients from 2012 to 2023 at the Regional University Hospital of Málaga. FV and ALT levels were measured on postoperative day 2, and patients were categorized based on FV <37.5 and ALT >1539. The association with 90-day graft loss was analyzed. Graft loss occurred in 43 patients (8.4%) within the first 90 days. The combination of FV <37.5 and ALT >1539 on postoperative day 2 demonstrated a specificity of 99% and a test efficiency of 94% in predicting graft loss. Patients meeting both criteria had a 74-fold increased risk of graft loss, with most losses occurring within the first week, and a median survival of 4 days. These findings suggest that FV and ALT on postoperative day 2 are reliable early markers for predicting graft loss, enabling risk stratification and guiding critical decisions regarding early retransplantation in the immediate postoperative period.

Description and Outcomes of an Ultrasound-Guided Technique for Catheter Placement in the Canine Quadratus Lumborum Plane: A Cadaveric Tomographic Study and Clinical Case Series.

This study aimed to describe an ultrasound-guided technique for implanting catheters for local anesthetic administration into the quadratus lumborum (QL) inter-fascial plane in canine cadavers and assessing the spread along the vertebral bodies (VBs) by computed tomography (CT). Phase 1: eight canine cadavers received one catheter per hemiabdomen, followed by injection of contrast media solution [low volume (LV) 0.3 mL kg-1 or high volume (HV) 0.6 mL kg-1]. Phase 2: postoperative pain of five dogs was managed by injecting 0.3 mL kg-1 of ropivacaine 0.5% through QL catheters every eight hours, up to 72 h after abdominal surgery. Pain was assessed using the Short Form of the Glasgow Composite Measure Pain Scale, and methadone 0.2 mg kg-1 was administered intravenously when the pain score was ≥6. The number of VBs stained by the contrast solution between the QL and psoas minor muscles was significantly higher in group HV than group LV. The catheter tip was visualized in the retroperitoneal space in 1/16 and 2/10 hemiabdomens in phases 1 and 2, respectively. Rescue analgesia was required in 3/5 dogs during the postoperative period. The QL catheter placement technique appears feasible and may be included in a multimodal analgesic approach for dogs undergoing abdominal surgeries.

CLINICAL CASE OF A NEW METHOD FOR SURGICAL TREATMENT OF HILL-SACHS REVERSAL FRACTURE IN OLD-ENGINED POSTERIOR SHOULDER DISLOCATION.

The article presents a clinical case in which the use of a new method of surgical treatment of a HILL-SACHS type reversal fracture in chronic posterior shoulder dislocation is considered. In this clinical case, we proposed an operational-biomechanical theory, the main goal of which is surgical treatment of a HILL-SACHS reversal fracture with stabilization of the shoulder joint by moving the tendon of the long head of the biceps to the impression zone and fixing it with anchors. The outcome of this clinical case is the absence of clinical symptoms of instability of the shoulder joint and restoration of function of the shoulder joint in the late postoperative period.

Transmitral Pressure Gradients in Patients With Degenerative Mitral Regurgitation After Robotic Mitral Valve Repair With Leaflet Preservation Techniques.

The hemodynamic effects of mitral valve repair (MVr) with respect to transmitral pressure gradients (TMPGs) have not been described well in patients undergoing leaflet preservation techniques. In a population of patients undergoing robotic MVr with leaflet preservation, we investigate the expected change of the postrepair intraoperative TMPG in the postoperative follow-up period. We retrospectively studied 144 adult patients who underwent robotic MVr. Demographic, clinical, procedural, and echocardiographic data were collected and analyzed. We found a slight increase in the mean TMPG from the intraoperative postrepair to the immediate postoperative period (intraoperative 3.3 ± 1.4mmHg vs. first postoperative transthoracic echocardiography [TTE] follow-up 3.6 ± 1.9mmHg, p = 0.016) with a gradual decline in the long-term follow-up (mean TMPG at last follow-up TTE 2.4+2.1mmHg). When dichotomizing the patient population using a cutoff of 3mmHg for the intraoperative mean TMPG, patients with an intraoperative mean TMPG > 3mmHg had higher mean TMPG gradients at first TTE (4.5 ± 2.4 vs. 3.1 ± 1.3mmHg, p<0.001) as well as at last TTE (3.0± 2.2 vs. 2.1 ± 2.0mmHg, p = 0.01) when compared with patients with an intraoperative mean TMPG ≤ 3mmHg. There was no difference in clinical outcomes. Although the hemodynamic effect of MVr seems to be small, patients with an intraoperative TMPG > 3mmHg have a higher mean TMPG at follow-up. The hemodynamic effect does not seem to have an impact on clinical outcome.