Postoperative Clinical Parameters Research Articles

Short-term outcomes of gradual ulnar lengthening in multiple hereditary osteochondromas of the forearm with monolateral external fixator.

Hereditary multiple exostoses is an autosomal dominant genetic condition primarily affecting long bones. Forearm deformities, including wrist ulnar deviation, ulnar shortening, radial or ulnar bowing, and radial head dislocation, are common manifestations. Gradual ulnar lengthening is suggested as a viable treatment option for managing these deformities. This retrospective single-center study included 15 forearms treated with gradual ulnar lengthening using a monolateral external fixator by a single surgeon. Clinical and radiological characteristics were recorded preoperatively and during follow-ups. The Wilcoxon signed-rank test compared preoperative and postoperative radiological and clinical parameters, while McNemar's test assessed changes in radial head dislocation or subluxation. Significant radiological improvements were observed post-treatment. Proportional ulnar length increased from a mean of 0.85 ± 0.10 preoperatively to 1.11 ± 0.03 at the last follow-up (P < 0.001). Ulnar variance decreased from a mean of 17.6 ± 5.58 mm preoperatively to 0.13 ± 1.81 mm at the last follow-up (P < 0.001), while radial bowing decreased from a mean of 0.06 ± 0.02 to 0.05 ± 0.01 at the last follow-up (P < 0.001). In addition, the radioarticular angle decreased significantly from a mean of 29.93 ± 7.34 to 20.20 ± 5.71° (P < 0.001). The incidence of radial head dislocation or subluxation decreased significantly, from 11 patients preoperatively to only one at the last follow-up. These findings demonstrate the effectiveness of gradual ulnar lengthening with a monolateral external fixator in correcting forearm deformities and reducing the incidence of radial head dislocation or subluxation.

A novel unilateral extrapedicular approach applied to percutaneous vertebral augmentation to treat thoracic and lumbar Osteoporotic Vertebral Compression Fracture: a retrospective study

ObjectiveTo design and apply a novel puncture method, named P TO P technique, and to evaluate its efficacy and safety.MethodThe data of patients treated with PVA in medical institution from January 2020 to December 2022 were reviewed and analyzed. The degree of pain relief and recovery from daily activities were evaluated using VAS and LAS scores, and radiological parameters were evaluated using local kyphosis angle and excellent cement distribution. Complications such as cement leakage and recurrent vertebral fractures were also recorded.Results157 patients with thoracolumbar OVCF were successfully treated with novel puncture techniques. All postoperative clinical and radiological parameters significantly decreased in all patients, except for an increase in local kyphosis angle at the last follow-up compared to postoperative. All other above indicators remained statistically significant at the last follow-up compared to postoperative improvement. Except for 2 patients with poor cement distribution, the remaining 155 patients successfully achieved satisfactory results in unilateral puncture and bilateral cement distribution, achieving an excellent rate of 98.73%. In addition, 18 cases (11.46%) of cement leakage occurred during the operation, fortunately none of them were uncomfortable. During the postoperative follow-up period, 4 cases (2.55%) of recurrent fractures occurred. No other serious complications such as neurologic or named vascular injuries occurred.ConclusionThe application of P TO P technology in thoracolumbar OVCF patients is safe and effective. It can not only reduce pain and quickly recover daily activities, but also achieve the perfect effect of unilateral puncture and bilateral cement filling.

Three-year results of XEN gel stent implantation in the treatment of glaucoma

Objective: To evaluate the long-term efficacy and safety of XEN gel stent implantation in patients with refractory glaucoma. Methods: A retrospective case series study was conducted. Clinical data were collected from patients who received medical treatment at the First Affiliated Hospital of Fujian Medical University between January 2020 and September 2020 and underwent XEN gel stent implantation by the same surgeon. Preoperative and postoperative clinical parameters, including the intraocular pressure (IOP), number of ocular hypotensive medications, best-corrected visual acuity, surgical success rates, status of filtering blebs, and complications, were recorded at 1 day, 1 week, 1, 2, 3, 6, 12, 18, 24, and 36 months after surgery. Statistical analyses were performed using the analysis of variance (ANOVA), the least significant difference (LSD) method, and the Fisher's precision probability test. Results: A total of 8 patients (8 eyes) with glaucoma meeting the criteria were included, consisting of 6 males (6 eyes) and 2 females (2 eyes). The preoperative IOP reached (30.88±12.17) mmHg (1 mmHg=0.133 kPa), and the IOP at all postoperative follow-up time points was significantly lower than the preoperative value (P<0.05). At 3 years after surgery, the IOP was (14.38±1.60) mmHg, with a reduction of 53.43% [(16.50±12.07) mmHg]. Only 2 patients required monotherapy for IOP control, and there was no significant decline in best-corrected visual acuity in 7 patients. The surgical outcome at 3 years postoperatively was a complete success in 6 patients, a qualified success in 1 patient, and a failure in 1 patient. The filtering blebs were generally flat and diffuse, with only mild to moderate vascularization. One patient presented elevated IOP at 3 months, and after a subsequent revision of the XEN gel stent, the IOP became stable with the administration of travoprost eye drops. Conclusion: The XEN gel stent implantation proved to effectively reduce the IOP in glaucoma patients, with a high degree of safety demonstrated up to 3-year long-term follow-up.

Retroperitoneal vs transperitoneal laparoscopic pyelolithotomy; a single surgeon's experience.

To compare the outcomes of transperitoneal and retroperitoneal laparoscopic pyelolithotomy procedures. A total of 104 consecutive laparoscopic pyelolithotomy surgeries performed by a single surgeon on patients with staghorn or renal pelvic calculi larger than 20mm were evaluated. Intraoperative and postoperative clinical parameters from two groups, transperitoneal (TLPL) (N = 55) and retroperitoneal (RLPL) (N = 49), were compared. The surgeon performed TLPL for the first five years and then switched to the RLPL approach for the next five years. There were no significant differences in general demographic variables and stone size (26.55 vs. 24.73mm, P = 0.8). Operation time and change in serum creatinine levels did not significantly differ between the two approaches. However, patients who underwent TLPL had longer hospital stays than RLPL (3.23 ± 1.21 vs. 2.36 ± 1.10 days, P = 0.0001). Additionally, TLPL was associated with a greater drop in hemoglobin levels (1.53 ± 1.04 vs. 1.17 ± 0.68, P = 0.04), higher rates of postoperative fever (12.7% vs. 0.0%, P = 0.01). The retroperitoneal approach in laparoscopic pyelolithotomy for large renal pelvic stones resulted in fewer postoperative fevers, reduced hemoglobin drops, and shorter hospital stays than the transperitoneal approach. However, the stone-free rates were similar for both groups.

Endoscopic balloon dilatation of primary obstructive megaureter: An effective first line management in children

This study evaluates outcomes of endoscopic balloon dilatation (EBD) in the management of primary obstructive megaureter (POM) in children. Retrospective data between 2013 and 2023 from two tertiary paediatric surgical centres in the UK were reviewed. Pre and post-operative clinical and imaging parameters of children managed with EBD were assessed. Failure of procedure was defined as requiring further intervention due to persistent/recurrent symptoms, upper tract dilatation and/or obstruction on MAG3 over the follow up period. 55 children with 61 renal units were evaluated. Median age at treatment was 18 months with a median follow up of 24 months. There was significant reduction in upper tract ultrasound measurements following balloon dilatation but there was no significant difference between the pre and post-operative renal function on MAG3. No significance difference was demonstrated when the outcomes of cutting and non-cutting balloons were compared. No significant difference was shown when outcomes after EBD were compared between infants vs older children as well as ureteric dilatation less than or over 25mm (p=0.841). 87% were successfully treated with a single dilatation and this increased to 95% after second dilatation. The remaining 5% had ureteric re-implantation. Although a retrospective study, the patient population is relatively large. 87% success rate shown after EBD is comparable to similar studies. It has been suggested that children less than 12months and those with severe ureteric dilatation (>25mm) may not be suitable for EBD. No significant difference was demonstrated when the outcomes of these categories of children were compared to other children with POM. All of the patients that had repeat balloon dilatation required no further intervention, a finding that has so far not been well evaluated in available literature. This study demonstrates 87% success rate after single EBD in children with POM and this outcome increased to 95% following a second dilatation. EBD is shown to be an effective definitive surgical management option of POM. It can be safely offered as first line management in all patient groups and repeated if no initial response.

Comparison of the effects of 0.05% topical cyclosporine A versus 0.1% topical cyclosporine A on recurrence and clinical parameters following pterygium surgery.

To compare the efficacy of topical 0.05% cyclosporine A (CsA) and 0.1% topical cyclosporine A (CsA) over a 6-month period following pterygium surgery, specifically evaluating their effects on postoperative recurrence and clinical parameters. This clinical study enrolled 245 patients with pterygium who underwent surgery using the conjunctival autograft technique with mitomycin C (MMC) were enrolled. Participants were divided into three groups: Group 1 (0.05% CsA) (n = 80), Group 2 (0.1% CsA) (n = 80), and a control group (n = 85). They were examined at postoperative first day, first week, first month and sixth month. The examination included best corrected visual acuity (BCVA), intraocular pressure (IOP), presence of inflammation, and ptergium recurrence, all of which were compared across the groups. The mean age of the patients was 63.22 ± 9.39 years, with 53.3% male and 46.7% female. The three groups were similar in terms of demographic characteristics and pterygium size. Inflammation in surgical area significantly regressed in all groups at 6 months postoperatively (p < 0.05). Inflammation in the first and sixth months was not different between the groups (p = 0.118, p = 0.580, and p = 0.435, respectively). The recurrence rate was not different between groups (p = 0.890). There was no statistically significant difference between groups regarding IOP (p = 0.818). A significant increase in BCVA after surgery was observed in three groups compared to preoperative levels (p < 0.05). This study showed that there was no difference between the efficacy of 6 month topical 0.05% CsA and 0.1% CsA application after pterygium surgery with the conjunctival autograft technique with MMC on postoperative outcomes. Including postoperative recurrence, IOP changes, BCVA changes and surgical area inflammation.

Step-cut osteotomy for cubitus varus deformity with application of patient-specific instrument in children: a preliminary report.

The step-cut osteotomy has been recognized as a valuable approach for addressing cubitus varus deformity, albeit one that necessitates technical proficiency. This study aims to evaluate the efficacy of the modified step-cut osteotomy technique in conjunction with patient-specific instruments by clinical and radiological assessment. We conducted a retrospective review of patients who underwent modified step-cut osteotomy with the use of patient-specific instruments in conjunction with Kirschner wires fixation for the correction of cubitus varus deformity between April 2016 and April 2022. Follow-up was performed for a minimum of two years, during which pre-operative and post-operative clinical and radiological parameters were compared. Fifteen patients were enrolled in this study. The mean pre-operative humeral-elbow-wrist (HEW) of the affected side was -21.7° (ranging from -14° to -34°), while the normal side was 9.4° (ranging from 5° to 15°). The post-operation HEW of affected side was 9° (ranging from 4° to 16°). There was no significant difference between the normal side and affected side after operation (p = 0.74). Pre-operative range of motion in the affected side was 130°, while the post-operative range of motion was 132°. Fourteen patients (93.3%) were pleased with the overall appearance of their elbow. None lazy-S deformity was observed in these cases. There were no major complications. The modified step-cut osteotomy technique, utilizing patient-specific instrument in conjunction with Kirschner wires fixation was found to be a safe, reliable, and technically easy procedure for correcting cubitus varus deformity.

Left bundle branch area pacing optimized cardiac resynchronization therapy (LOT CRT) -comparative results to a CRT implanted patient population

Abstract Background Cardiac resynchronization therapy (CRT) is gold standard treatment option among patients with symptomatic heart failure with reduced left ventricular ejection fraction (LVEF) and intraventricular conduction delay of left bundle branch block (LBBB) morphology. Purpose Left bundle branch area pacing optimized cardiac resynchronization therapy (LOT CRT) is a novel and promising approach for CRT candidate patients even in advanced intraventricular conduction delay, however convincing follow-up data regarding this patient group is still lacking. Methods In our observational registry 35 LOT CRT vs. 35 conventional CRT patients were consecutively implanted according to current guidelines. All the patients had LBBB morphology QRS width of &amp;gt;150 ms. The two compared patient group did not show significant difference in age, gender, baseline non-ischemic etiology, LVEF, NYHA functional class, LBBB QRS width. Results Immediate postoperative results showed significantly increased QRS width reduction (p=.028) and at 6 months of follow-up a significantly greater improvement in LVEF(p=.031), NYHA functional class (p=.04) and Nt-ProBNP levels (p=0.043) were seen in LOT CRT patient group compared to conventional CRT patients. Conclusion Our single center observational study showed significant improvement in prompt postoperative QRS width and clinical follow-up parameters in LOT CRT implanted patients compared to conventional CRT implanted patients.LOTCRTvs.CRTQRSwidthreductionLOTCRTXray

LVentral tethering-is the prognosis worse than in dorsal tethering in the dysraphic spine?

To compare cases of dysraphism with ventral tethering of cord with those with dorsal tethering and to find out any differences in the outcome of surgery in them. We collected the data of 188 consecutively operated tethered cord patients at our institute in the past 7years and divided them into ventral tethering and dorsal tethering groups. Those that we felt had both dorsal and ventral tethering were excluded. Their preoperative clinical, radiological, and baseline neurophysiological parameters as well as postoperative clinical and radiological parameters were analyzed in a retrospective study. Among the 188 tethered cord patients, 52 (28%) had ventral tethering and 136 (72%) had posterior tethering. Preoperative neurodeficit and cord signal changes as well as absent baseline MEP (of any one muscle) were significantly more associated with ventral tethered cord than the dorsal tethered cord. The neurological deterioration after surgery occurred significantly in the ventral tethered cord group than in the dorsal tethered cord group. Also, the postoperative MRI had more incomplete detethering cases in the ventral group than in the dorsal tethered cord group. Ventral tethered cord is more likely to present with preoperatively neurological deficits. It should be carefully identified in the preoperative MRI, so that the intraoperative difficulties in complete detethering and postoperative deterioration can be anticipated.

Mini-Craniotomy for Chronic Subdural Hematoma: A Reliable Surgical Option.

Introduction Chronic subdural hematoma (SDH) is one of the most common conditions encountered in the neurosurgical practice. Surgical modalities like twist drill craniostomy, burr hole evacuation, mini-craniotomy, and craniotomy are practiced in the management of chronic SDH. Mini-craniotomy without excision of membranes may help to achieve best results with decreased complication rate. Materials and Methods Patients with chronic SDH operated from September 2013 to September 2022 were included in the study. Mini-craniotomy (40-60 mm) was done and cruciate incision was given over the dura. Dura was left wide open by reflecting and suturing the cut edges of the dural leaflets to the craniotomy edge allowing to evacuate subdural space under vision during surgery and to allow any residual collection to drain out freely in the postoperative period. A drain was placed between the inner membrane and the bone flap. Preoperative and postoperative clinical and radiological parameters were recorded. Complications, recurrence, and residual collections were noted. Results Seventy-seven patients were included in the study. Mean age was 57.32 years. Median Glasgow Coma Scale (GCS) at presentation was 13 while median GCS at discharge was 15. Two patients with preexisting comorbidities expired after surgery due to medical causes. No recurrences were noted. Fourteen patients had residual collections which resolved by 6 weeks. Two patients had wound infection. One of these patients later needed a bone flap removal due to osteomyelitis. Conclusion Mini-craniotomy without membranectomy is a good option for complete evacuation of chronic SDH under vision mainly avoiding the complication of membranectomy. It is not associated with increased complications rate. It needs fewer follow-ups as brain expansion can be established radiologically in a short period.

Less Invasive Triangular Osteosynthesis in the Management of AO Type-B Unstable Sacral Fractures

Objective: This prospective cohort study investigated the clinical and radiological efficacy of triangular osteosynthesis (TO) in the management of AO type-B unstable sacral fractures.Methods: All patients with unstable AO type-B sacral fractures were included in this study. They were evaluated clinically and radiologically and underwent TO. Pre- and postoperative clinical parameters included the visual analogue score (VAS) for back pain, Oswestry Disability Index (ODI), and Gibbon classification. Radiological parameters included x-rays and multislice 3-dimensional computed tomography scans of the pelvis and the Tornetta and Matta criteria for fracture reduction.Results: This study included 30 patients (17 males and 13 females; mean age, 31.63±9.65 years). The reported causes of trauma were a fall from height in 17 patients, road traffic accident in 11 patients, and hard objects falling onto the pelvis in 2 patients. According to the AO spine sacral fracture classification system, 8 cases were type B2 and 22 were type B3. At the last postoperative follow-up, the mean VAS improved from 7.77±1.19 preoperatively to 3.97±1.59 (p&lt;0.001), the mean ODI was 15.27±3.34, and the Gibbon classification of cauda equina injury improved from 2.87±0.97 preoperatively to 1.27±0.52 (p&lt;0.001). According to Tornetta and Matta criteria for fracture reduction, the results were excellent (&lt;4 mm) in 73.3% of patients, good (4–10 mm) in 20%, and fair (10–20 mm) in 6.7%. All patients experienced complete fracture healing.Conclusion: TO is a less invasive, safe, and effective option for the management of unstable AO type-B sacral fractures with good clinical and radiological outcomes.

Arthroscopy Treatment of Scaphoid Pseudarthrosis: Description of the Technique and Case Series.

Objective To describe the procedure and evaluate the results of a series of patients with stable and unstable pseudarthrosis of the scaphoids treated with the use of arthroscopy associated with cancellous bone graft and compression screw. Methods Twenty-three patients were treated with this technique. The minimum postoperative follow-up was 12 months, and pre- and postoperative functional, clinical, and imaging analyses were performed. Results Themean time from fracture to surgery was 26 months (12-60). Preoperative and postoperative clinical and radiological parameters were analyzed. The mean follow-up was 24.2 (12-60) months. Consolidation occurred in 22 patients (95.6%) in an average of 7.5 (4-12) weeks. Mean flexion range ofmotion improved from73.6° (60-80°) to 79.5° (60-90°); the range from 68.6° (50-80°) to 71.9° (45-85°); ulnar deviation from 20.6° (15-30°) to 26.9° (20-35°); and the radial deviation from 17.3° (15-25°) to 20.4° (10-25°). Pain (Visual Analog Scale [VAS] 0-10) improved from 7.3 (4-9) to 0.7 (0-6) and DASH functional scale improved from 49 (32-75) to 6 (2-12). The scapholunate angle improved from 69.1° (55-85°) to 48.4° (40-55°) and the radiolunar angle improved from 30° (10-40°) to 2.6° (0-8°). Conclusion Treatment of stable and unstable pseudarthrosis of the scaphoid with spongy bone graft and percutaneous internal fixation, preferably with a headless compression screw, assisted by arthroscopy, showed good clinical and radiographic results in our series, with a short time for consolidation and functional recovery.

Comparison of suture and sutureless techniques on postoperative complications after third molar surgery: a systematic review.

To compare, among patients undergoing third molar surgeries, whether the use or omission of sutures improves postoperative clinical parameters. A systematic literature review was conducted to identify randomized clinical trials in humans. The steps of this review were conducted following the PRISMA protocol. The risk of bias assessment was performed using the revised Cochrane tool (RoB 2). The RevMan software was employed for meta-analyses, and the quality of evidence was evaluated using GRADE. A total of seven articles were included in the systematic review; however, only one article quantitatively measured bleeding, rendering meta-analysis for this outcome unfeasible. The group of patients in whom sutures were not used presented lower pain and edema on the first day (respectively: MD - 1.08; 95% CI - 1.35 to - 0.81; MD - 1.23; 95% CI - 2.34 to - 0.11) and second day (respectively: MD - 0.50; 95% CI - 0.83 to - 0.17; MD - 10.66; 95% CI - 1.16 to - 0.16) postoperatively, compared to the group where sutures were employed. The group of patients who received sutures exhibited increased trismus on the first day postoperatively (MD 1.04; 95% CI 0.67 to 1.41). The omission of postoperative sutures in third molar surgeries appears to favor pain and edema outcomes within the first 24h after the procedure, as well as trismus within the same timeframe. Despite the suture being the standard conduct in tooth extractions. The omission of sutures in third molar extractions may favor inflammatory outcomes of pain, edema, and trismus in the immediate postoperative period.

Impact of three-dimensional heads-up display on surgical performance, ergonomics and teaching in vitreoretinal surgery: first African study

PurposeTo assess the impact of a Three-Dimensional (3D) Heads-Up Display (HUD) compared to a conventional microscope (COVM) on surgical performance, ergonomics, and teaching in vitreoretinal (VR) surgery. DesignA single-center, retrospective cohort study and cross-sectional survey. MethodsSurgical assistants (N = 12) and Vitreoretinal Surgeons (N = 2) were asked, in the survey arm, to complete a questionnaire regarding various parameters related to ergonomics, quality of visualization, quality of teaching, and overall satisfaction. Parameters were rated on a scale from 1 to 10 for both the 3DHUD and COVM visualization systems (VS). The scores of the two groups were compared using appropriate statistical tests. The retrospective arm of the study included 34 consecutive cases that underwent vitrectomy with the 3DHUD VS compared to 32 matched controls with the COVM. Demographics and preoperative, intraoperative, and postoperative clinical parameters were identified in both groups and were compared using appropriate statistical tests. ResultsSurvey scores were significantly higher in the 3DHUD VS group when compared to the COVM VS group for both Surgeons and Assistants regarding ergonomic parameters (overall comfort (p < 0.001), neck pain (p < 0.001), and lower back pain (p < 0.001)), visualization parameters (overall visibility (p < 0.001), visibility of the macula (p < 0.001), depth of field (p < 0.001), and quality of magnification (p < 0.001)) and teaching parameters (understanding of surgical steps by assistants (p < 0.001) and teaching to medical students and residents (p < 0.001)). Both demographics and clinical data of cases operated with the 3DHUD VS and COVM VS were comparable (p > 0.05). Anatomical and functional outcomes were similar in both groups (p > 0.05); nevertheless, mean surgical time was significantly longer in the 3DHUD group for tractional retinal detachments (p < 0.001), epiretinal membranes, and phacofragmentation (p = 0.03). Conclusion3DHUD greatly enhances ergonomics during vitreoretinal surgery and represents a significant innovation in the teaching armamentarium within the operating room. It provides the same surgical view for both the surgeons and assistants with an unparalleled image quality. A learning curve and an integrated ecosystem may be necessary to maximize its potential and reduce surgical time.

Combined Distal Metatarsal and Akin Osteotomies for Concomitant Metatarsophalangeal and Interphalangeal Hallux Valgus: Clinical and Radiological Outcomes

Combined metatarsal and Akin-type proximal phalanx osteotomies represent a surgical solution for concomitant metatarso-phalangeal and inter-phalangeal hallux valgus. This retrospective observational study aimed to evaluate clinical and radiographic outcomes following combined distal linear metatarsal and Akin osteotomies. The study included 42 feet from 37 patients, with a mean follow-up of 27.1 (range 24-37) months. Mean surgical time was 16.54 ± 4.17 minutes. Pre- and postoperative clinical scores and radiological parameters were collected. Positive outcomes with a low recurrence and complications rates were reported. A statistically significant improvement in the Manchester–Oxford foot questionnaire, the EuroQol 5D-5L dimensions instrument, the visual analogue scale, the intermetatarsal angle, the hallux valgus angle, the distal metatarsal articular angle, and the interphalangeal angle correction was observed. Despite the results reported, further prospective studies are needed to identify the most suitable patients for this combined osteotomy approach.

Impact of L-PRF on pain and healing outcomes in lower third molar surgery: a randomized split-mouth trial.

This study explored the effects of L-PRF on pain, soft tissue healing, periodontal condition, and post-extraction bone repair of mandibular third molars (3Ms). A randomized, prospective, triple-blind, split-mouth clinical trial was conducted with 34 volunteers. Eligible patients were randomly allocated into two treatments: G1 (without L-PRF), G2 (alveoli filled with L-PRF), in which the removal of bilateral 3Ms was performed at the same surgical time. Outcomes were assessed according to a visual analogue scale (pain), soft tissue scoring system (wound healing), periodontal probing of mandibular second molar. Bone repair was determined by volumetric analysis (ITK-SNAP software) and fractal analysis (ImageJ software). An intention-to-treat approach to Statistical analysis was used. L-PRF reduced pain in the 7-day postoperative follow-up (p = 0.019) and not only improved soft tissue healing after 1 month of follow-up (p = 0.021), but also probing depth (distal face) in 3 months postoperatively (p = 0.011). Significant alveolar reduction occurred in 3 months after surgery in both treatments (p < 0.05), however, this was more significant in G1 (p = 0.016). The fractal dimension showed no statistical differences. L-PRF improved postoperative clinical parameters of pain, soft tissue healing, and periodontal condition, suggesting that it has a beneficial effect on preserving the alveolar ridge and accelerating the initial repair process.

Clinical and radiographic outcomes of a combined surgery approach to treat peri-implantitis

Peri-implant infra-bony defects are difficult to treat, and data on the management of peri-implantitis are lacking. The aim of this study was to evaluate the effect of a combined surgical approach to manage peri-implantitis: implantoplasty with xenogeneic bone grafting and a concentrated growth factor membrane. Two independent examiners analysed the medical records and radiographs taken before surgery and at the last follow-up. Data were analysed at the implant level; some patient-level data (age, sex, smoking habit) were also considered. Linear regression analysis with generalized estimating equations (GEE) was used to explore the effect of variables of interest (including marginal bone level (MBL)) on implantitis treatment success and resolution rates. The effect of the prosthesis type on postoperative clinical and radiographic parameters was also explored by GEE, with adjustment for age, sex, tooth site, location, follow-up duration, and implant length (model IV including all). Thirty patients with 72 implants were investigated. The implant survival rate was 100% over a mean observation period of 3.3 years (range 2–11 years). The treatment success rate (bone loss <0.5 mm, no bleeding on probing (BOP), no suppuration, probing depth (PD) < 5 mm) was higher in females than males (50% vs 19.0%; P = 0.008). At the last postoperative follow-up, the MBL (1.51 ± 1.07 vs 4.01 ± 1.13 mm), PD (3.61 ± 0.84 vs 6.54 ± 1.01 mm), and BOP (23.38 ± 23.18% vs 79.17 ± 15.51%) were significantly reduced when compared to pre-surgery values (all P < 0.001). Furthermore, a significantly higher PD reduction (β = −1.10 mm, 95% confidence interval −1.97 to −0.23 mm, P = 0.014) was observed for implants with a single crown than a full-arch prosthesis (GEE model IV). Preliminary clinical and radiographic data indicate that implantoplasty in combination with surgery could be an effective treatment option for peri-implantitis.

Early outcomes of total hip arthroplasty using point-of-care manufactured patient-specific instruments: a single university hospital’s initial experience

BackgroundThe use of 3D-printed Patient-Specific Instruments (PSI) has been investigated to enhance the postoperative functional results in total hip arthroplasty (THA) and has been recognized as an innovative approach for the optimal alignment of hip implant components. Point-of-care production is gradually becoming the norm for PSI manufacturing. The purpose of this article is to assess the accuracy and safety of PSI for total hip arthroplasty performed at the point-of-care in Vietnam.Methods34 THA cases were assessed in this prospective study. A template for the size and orientation of the implant and the design of the PSI was generated using data from preoperative 3D computed tomography (CT) scanning of the lower limb. The principal surgeon determined the implants’ position and PSI design directly using the software. The PSI is then produced using a 3D-compatible resin printer in our manufacturing hospital. The PSI, consisting of an acetabulum and a femoral component placed press-fit on the bony surface, guided surgeons to precisely ream the acetabulum and cut the femoral neck according to the pre-planned plane. Postoperative CT scanning was obtained and superimposed onto the 3D model of the implant to evaluate the accuracy of the procedure by comparing the orientation values of the cup and the alignment of the stem between the planned and the actual results. Intra- and postoperative clinical parameters of surgery, including surgical time, intra-operative blood loss, complications, and the first ambulation, were also recorded to evaluate the safety of the surgery.ResultsThe preparation for PSI required an average of 3 days. 94% of cup size and 91% of stem size were correctly selected. The mean values of postoperative inclination and anteversion were 44.2° ± 4.1° and 19.2° ± 5.6°, respectively. 64.7% of cases deviated from planned within the ± 50 range and 94.1% within the ± 10° range. There was no significant statistical difference between the planned and the achieved values of stem anteversion, osteotomy height, and leg length discrepancy (p > 0.05). The average surgical time was 82.5° ± 10.8 min, and the intraoperative blood loss was estimated at 317.7° ± 57.6 ml. 64.7% of patients could walk on the day of surgery. There were no complications reported.ConclusionsThe point-of-care manufactured PSI is a useful solution for improving the accuracy of total hip arthroplasty surgery, especially in restoring implant orientation and reducing leg length discrepancy. However, long-term clinical follow-up evaluation is needed to confirm the efficacy and safety of this approach.

Angiographic definition, incidence, predictors and clinical impact of early coronary graft failure in patients undergoing coronary artery bypass graft surgery

Abstract Introduction Coronary graft failure (CGF) may occur early after coronary bypass graft surgery (CABG), potentially leading to adverse clinical outcomes. However, data regarding incidence, diagnostic strategies and identification of individuals at risk of developing early CGF are scarce. Purpose The aim of this study was to establish a definition of early CGF based on invasive coronary angiography (CAG), to identify clinical and perioperative risk factors of early CGF and to define the clinical impact of early CGF in terms of major adverse cardiovascular events (MACE: death, myocardial infarction and revascularisation) at 5-years follow-up. Methods This retrospective observational study included CABG patients who underwent CAG prior to post-surgery discharge between 2012-2022 in a tertiary center. The decision to perform a CAG was based on clincal criteria indicative of myocardial ischemia. All CAGs were reviewed by two interventional cardiologist and a thoracic surgeon. Early CGF was defined as a dysfunctional coronary graft resulting from any of the following angiographic findings: stenosis of proximal or distal anastomosis, stenosis of the bypass conduit, bypass occlusion, reduced bypass flow (TIMI&amp;lt;1) and kinking/tenting/dissection of the bypass leading to lumen reduction. Clinical data and ECG recordings during hospitalization were collected. Comparisons between patients with vs. without early CGF were performed. Kaplan-Meier analysis was performed to estimate cumulative survival free of MACE at 5-years follow-up. Multivariate analysis was performed to identify predictors of early CGF. Results A total of 92 patients (79% male, 66.1±10 years-old) were included. CGF was present in 55 patients (60%). Compared to the patients without graft failure (n=37 (40%), there were no differences in baseline demographics and intra- and postoperative technical and clinical parameters. At 5-years follow-up, MACE was observed in 57 patients (18 death, 34 myocardial infarction, 42 revascularization). There were 50 revascularization procedures performed in 42 patients (46%). Of them, 35 (83%) were performed in patients with early CGF vs. 7 (17%) in patients without CGF (p&amp;lt;0.001). Patients with early CGF showed a significantly lower MACE-free five-year survival rate (p&amp;lt;0.001) (Figure) 1). On multivariate analysis, venous grafts (p=0.006), Y-graft configuration (p&amp;lt;0.001) and the need of inotropic agents for hemodynamic support (p=0.029) showed a significant association with early CGF. Conclusion In CABG patients undergoing clinically indicated CAG prior to discharge, early CGF was observed in 60%. Most patients underwent new revascularisation. Patients with early CGF showed a higher rate of MACE at 5-years follow-up, emphasizing the necessity to recognize and treat CGF. Venous grafts, Y-graft configuration and the need of inotropic agents for hemodynamic support 12h postoperatively were associated with early CGF.

The effect of body mass index on quality of life in modified single stoma cutaneous ureterostomy or ileal conduit after radical cystectomy.

To explore the influence of postoperative body mass index (BMI) change on postoperative quality of life (QOL) in patients undergoing radical cystectomy (RC) plus modified single stoma cutaneous ureterostomy (MSSCU) or ileal conduit (IC). Patients were divided into two groups according to different BMI change patterns: patients experiencing an elevated postoperative BMI level, along with a clinically significant increase in their BMI (an increase of more than 10%) were categorized as Group 1, while patients experiencing a decrease postoperative BMI level, along with a clinically significant reduction in their BMI (a decrease of more than 5%) were categorized as Group 2. Spearman correlation analysis was used to examine the correlations between quality-of-life scores and postoperative clinical parameters. Spearman correlation analysis showed that postoperative BMI, late complications and catheter-free state were significantly associated with postoperative global QoL and symptom scale in MSSCU and postoperative global QoL and physical scale in IC patients. Additionally, postoperative BMI, catheter-free state and the use of adjuvant therapy were associated with bad performance in many scales of QoL like body image, future perspective, social scale, future perspective (MSSCU), and abdominal bloating (IC) (Table2, p<0.05). Patients in Group 2 with significant weight loss had a better Global QoL, a lower rate of stomal stricture and a higher catheter-free state compared with those in Group 1 in both IC and MSSCU patients. MSSCU patients in Group 2 could achieve a comparable Global QoL as to IC patients in Group 1. Controlling the substantial increase in body weight after surgery contributes to improving QoL, reducing the occurrence of stomal stricture, and ensuring a postoperative catheter-free state in BCa patients undergoing MSSCU.