Postoperative Clinical Recovery Research Articles

Impact of Time from Injury to Surgery on Postoperative Functional Recovery in Large Volume Traumatic Extradural Hematomas

Abstract Background In traumatic brain injury (TBI) patients, the time from trauma to cranial surgery is always of great concern to patients and neurosurgeons. Patients and Methods A retrospective study conducted on 93 TBI patients presented with Glasgow Coma Scale from 4 to 13 and were operated for large volume (≥ 40 cm3) extradural hematoma (EDH) from July 2020 to December 2022. Surgery was done either within 6 hours following trauma (group A) or later than 6 hours (group B). We evaluated the impact of time from injury to surgery on postoperative clinical recovery, survival, and hospital stay. Results Fifty patients (53.8%) were operated upon within 6 hours after trauma and 43 patients (46.2%) had operations later than 6 hours. No significant difference was found between the two study groups regarding any of the preoperative clinical or radiological factors except for the mean time from injury to surgery (p < 0.001). Delayed surgery > 6 hours was significantly associated with higher postoperative mortality (p = 0.014). Hospital stay was significantly shorter in patients operated ≤ 6 hours (p = 0.006). Patients operated ≤ 6 hours showed significantly favorable functional recovery both at discharge (p = 0.010) and after 1 month of follow-up (p = 0.023). Conclusion Timely surgical intervention for large volume traumatic EDH is the gold standard. Early surgery “within 6 hours from trauma” not only can save patients' life but also is significantly associated with postoperative favorable clinical recovery, low morbidity, and short hospital stay.

An insight into artificial intelligence and its role in neurosurgery

To acquire a wide range of technical skills, neurosurgeons undergo extensive and drawn-out training. Additionally, neurosurgery necessitates a significant amount of preoperative, intraoperative, and postoperative clinical data collection, decision-making, care, and recovery. The significance of artificial intelligence in neurosurgery has significantly increased during the past ten years. The potential of artificial intelligence to improve diagnostic and prognostic outcomes in neurosurgery is quite promising. It is important to clinical therapy because it helps neurosurgeons make crucial decisions during surgical interventions to improve patient outcomes and it enhances their abilities to give patients the finest interventional and non-interventional care possible. Furthermore, the acquisition, processing, and storage of clinical and experimental data are all greatly influenced by artificial intelligence. Its application in neurosurgery can lower surgical care expenses and offer top-notch medical treatment to a larger population. This article examines the use of artificial intelligence in preoperative, intraoperative, and postoperative care for both interventional and non-interventional aspects of neurosurgery, including diagnosis, clinical decision-making, surgical operation, prognosis, data collection, and research in the field.

Central Atlantoaxial Dislocation: Presenting Symptoms, Diagnostic Parameters, and Surgical Treatment from Reports on 15 Surgically Treated Patients.

This chapter reviews the clinical entity of central or axial atlantoaxial instability (CAAD). From January 2018 to November 2020, 15 patients were identified as having CAAD, wherein there was no atlantoaxial instability when analyzed by conventional radiological parameters and wherein there was no evidence of neural or dural compression due to the odontoid process. The patients were identified as having atlantoaxial instability on the basis of the alignment of facets on lateral profile imaging and a range of telltale clinical and radiological indicators. The clinical statuses of the patients were recorded both before and after surgical treatment by using the specially designed Goel symptom severity index and visual analog scale (VAS) scores. All patients were treated via atlantoaxial fixation. There were six men and nine women ranging in age from 18 to 45years (average: 37years). The presenting clinical symptoms were relatively subtle and long-standing. Apart from symptoms that are generally related to neural compromise at the craniovertebral junction, a range of nonspecific cranial and spinal symptoms were prominent. The follow-up time after surgery ranged from 6 to 34months. All patients showed early postoperative and sustained clinical recovery. The correct diagnosis and appropriate surgical treatment of CAAD can provide an opportunity for quick and lasting clinical recovery.

The Correlation of Carpal Tunnel Pressure with Clinical Outcomes following Ultrasonographically-Guided Percutaneous Carpal Tunnel Release.

Background: To evaluate the correlation between carpal tunnel pressure (CTP) and the clinical presentations, and to explore the possible predictors for the postoperative recovery pattern in patients with carpal tunnel syndrome (CTS). Materials and Methods: Consecutive patients with idiopathic CTS following percutaneous ultrasound-guided carpal tunnel release (UCTR) were enrolled. CTP was measured preoperatively and immediately after operation. The Boston Carpal Tunnel Questionnaire (BCTQ) and the cross-sectional area (CSA) of median nerve were recorded preoperatively and at 1, 3, and 12 months postoperatively. Results: 37 patients (37 hands; 8 men and 29 females; median age, 59.0 years) were enrolled. CTP significantly decreased immediately from 40.0 (28.0–58.0) to 13.0 (8.0–20.0) mmHg after UCTR. BCTQ scores significantly improved at 1 month postoperatively, and the improvement trend persisted until 12 months postoperatively (p < 0.001). Preoperative CTP was positively correlated with preoperative CSA and preoperative BCTQ scores (p < 0.05, all). Using group-based trajectory modeling, all patients were categorized into the “gradual recovery” or “fast recovery” group. Higher preoperative CTP was significantly associated with a faster recovery pattern (odds ratio: 1.32). Conclusions: Preoperative CTP was well correlated with the clinical presentations and might be a useful predictor for the postoperative clinical recovery pattern.

The Challenges And Rapid Progression Associated With Cardiomyopathy In The Setting Of Danon Disease

In this case a 23 year old female patient was admitted to the intensive care unit (ICU) in January 2020 for veno-arterial extra-corporeal membranous oxygenation (ECMO) to manage cardiogenic shock and recurrent ventricular tachycardia (VT). She had no prior medical history or hospitalisations. Following a positive influenza B swab, elevated troponin I 37,656 ng/L with the clinical presentation, the patient was diagnosed with acute myocarditis. To out rule giant cell myocarditis an endomyocardial biopsy (EMB) was completed. EMB detected ‘vacuoles with cytoplasmic debris and glycogen particles' consistent with Danon Disease (DD). This diagnosis was supported by subsequent genetic screening determining a LAMP2 mutation the causal mutation in DD. The patient's echocardiogram showed severe concentric left ventricular hypertrophy (LVH) consistent with DD and a severely impaired ejection fraction (EF) of 35% (Image 1).The patient was closely monitored as an outpatient and initiated on goal directed heart failure medication. In January 2021 she was readmitted with decompensated heart failure. Troponin I was 12,369ng/L and NTProBNP 10,817ng/l. The admission echo showed a marked deterioration (EF<10%), increasing left ventricular dilatation (Image 1). Mixed venous saturation was 63%. Despite a successful discharge home, the patient was readmitted 6 weeks later with slow VT and cardiogenic shock. A mixed venous saturation was 45% prompting insertion of an intra-aortic balloon pump and the patient was listed on the heart transplant list. The time from index presentation to transplant listing was 425 days (14.2 months). After 3 days on the active list the patient had a successful orthotopic heart transplant (OHT) and discharged from ICU 3 days later. Following a final predischarge mixed venous saturation of 72% the patient was discharged home 28 days post OHT without any adverse complications. Conclusion:This case provides evidence supporting the theory that cardiomyopathies due to genetic abnormalities predispose towards myocarditis as evidenced by this patient. It highlights the importance in investigating potential genetic abnormalities in certain patients within the myocarditis population. Close surveillance of patients with a cardiomyopathy secondary to Danon disease is also paramount as it rapidly progressed to an advanced heart failure stage requiring OHT within 14 months of the patient's initial presentation. Timely listing for heart transplant ultimately contributed towards a successful and timely post-operative clinical recovery.

Full-Circle Cauterization of Limbal Vascular Plexus for Surgically Induced Glaucoma in Rodents.

Glaucoma, the second leading cause of blindness worldwide, is a heterogeneous group of ocular disorders characterized by structural damage to the optic nerve and retinal ganglion cell (RGC) degeneration, resulting in visual dysfunction by interrupting the transmission of visual information from the eye to the brain. Elevated intraocular pressure is the most important risk factor; thus, several models of ocular hypertension have been developed in rodents by either genetic or experimental approaches to investigate the causes and effects of the disease. Among those, some limitations have been reported such as surgical invasiveness, inadequate functional assessment, requirement of extensive training, and highly variable extension of retinal damage. The present work characterizes a simple, low-cost, and efficient method to induce ocular hypertension in rodents, based on low-temperature, full-circle cauterization of the limbal vascular plexus, a major component of aqueous humor drainage. The new model provides a technically easy, noninvasive, and reproducible subacute ocular hypertension, associated with progressive RGC and optic nerve degeneration, and a unique post-operative clinical recovery rate that allows in vivo functional studies by both electrophysiological and behavioral methods.

Postoperative clinical nursing care pathway for patients with mucormycosis: An experience from a tertiary care hospital in Rajasthan, India

BackgroundThe COVID-19 pandemic is a serious global health threat and it has numerous impacts on human life. India faced the problem of the second wave of COVID-19 and an unexpected new predicament in the form of mucormycosis has been added. The use of steroids drugs for long duration and comorbidity with COVID-19 infections are the risk factors of mucormycosis. It is important to understand the postoperative clinical pathway to assess and determine the policy and protocol, which help patients fasten their recovery, prevent further complications and readmission.MethodsA cross-sectional descriptive design was used to conduct the study. We adopted the validated Immediate Post-Operative Recovery Assessment (IPR-PA) Scale to assess the postoperative clinical nursing care pathway for patients with mucormycosis.ResultsThe current study shows that patients had highest score in the physiology clinical recovery domain (75.25%) and the lowest post-operative clinical recovery score in psycho-social domain (20.83%). There was a significant positive correlation was found between all the domains. The medication status domains found significantly associated with participants’ age (P=.021) and physiological domains has shown significant association with received oxygen therapy during hospitalization (P=.046).ConclusionPostoperative clinical nursing care pathway was effective to determine the progress of a patient. It helps us to know the parameter of different domains namely being physiological, physical, psycho-social and medication status. Patients required psycho-social support due to the epidemic and fear from disease.

Balanced forced-diuresis as a renal protective approach in cardiac surgery: Secondary outcomes of electrolyte changes.

ObjectivesForced‐diuresis during cardiopulmonary bypass (CPB) can be associated with significant electrolyte shifts. This study reports on the serum electrolyte changes during balanced forced‐diuresis with the RenalGuard® system (RG) during CPB.MethodsPatients at risk of acute kidney injury (AKI)—(history of diabetes &/or anaemia, e‐GFR 20–60 ml/min/1.73 m2, anticipated CPB time >120 min, Log EuroScore >5)—were randomized to either RG (study group) or managed as per current practice (control group).ResultsThe use of RG reduced AKI rate (10% for RG and 20.9% in control, p = .03). Mean urine output was significantly higher in the RG group during surgery (2366 ± 877 ml vs. 765 ± 549 ml, p < .001). The serum potassium levels were maintained between 3.96 and 4.97 mmol/L for the RG group and 4.02 and 5.23 mmol/L for the controls. Median potassium supplemental dose was 60 (0–220) mmol (RG group) as compared to 30 (0–190) mmol for control group over first 24 h (p < .001). On Day 1 post‐op, there were no significant differences in the serum sodium, potassium, calcium, magnesium, phosphate, and chloride levels between the two groups. Otherwise, postoperative clinical recovery was also similar.ConclusionsBalanced forced‐diuresis with the RG reduced AKI rates after on‐pump cardiac surgery compared to controls. Although the RG group required higher doses of IV potassium replacement in the postoperative period, normal serum levels of potassium were maintained by appropriate intravenous potassium supplementation and the clinical outcomes between groups were similar.

Early postoperative clinical recovery of robotic arm-assisted vs. image-based navigated Total hip Arthroplasty

BackgroundThis study compared the early clinical recovery of total hip arthroplasty (THA) using computer navigation systems (nTHA) and robotic arm-assisted THA (rTHA).MethodsThirty prospective subjects who underwent rTHA were clinically compared to 30 subjects who underwent nTHA. Clinical data (surgical time, intraoperative blood loss, pain severity, number of days to independent walking, and Harris Hip Score (HHS) at discharge), and radiographic parameters (inclination and anteversion angles) were statistically compared between the two groups.ResultsFollow-up times were 24.3 ± 6.0 and 27.0 ± 7.0 days in the rTHA and nTHA groups, respectively. The surgical time (135.1 ± 13.9 min vs. 146.2 ± 12.8 min, p = 0.002), number of days to independent walking (7.2 ± 2.0 vs. 11.5 ± 3.0 days, p < 0.001), and postoperative pain using a numeric rating scale on postoperative days 7, 10,, and 14 (1.4 ± 0.9 vs. 2.2 ± 1.2, p = 0.005; 1.0 ± 0.8 vs. 1.8 ± 1.1, p = 0.002; 0.3 ± 0.5 vs. 1.1 ± 0.9, p < 0.001; respectively) were significantly reduced in the rTHA group compared to the nTHA group. The rTHA group showed a significantly higher postoperative HHS compared to the nTHA group (85.3 ± .3.2 vs. 81.0 ± 8.5, p = 0.014). No statistically significant difference was observed in radiographic parameters between the groups; however, the incidence of intraoperative target angle changes was significantly lower in the rTHA group than in the nTHA group (0/30 subjects [0%] vs. 11/30 subjects [36.7%], p < 0.001).ConclusionThe surgical time, postoperative pain, and number of days to independent walking were significantly shorter, and the HHS at discharge was significantly higher in the rTHA group than in the nTHA group. Thus, compared to the nTHA group, the rTHA group showed improved early clinical recovery.

Is fresh, leucodepleted, whole blood transfusion superior to blood component transfusion in pediatric patients undergoing spinal deformity surgeries? A prospective, randomized study analyzing postoperative serological parameters and clinical recovery.

PurposeTo compare the effectiveness of fresh whole blood (FWB) and blood component transfusion in improving clinical outcome and serological parameters in the early postoperative period following spinal deformity surgery.MethodsPatients undergoing major spinal deformity surgeries involving ≥ 6 levels of fusion and expected blood loss ≥ 750 ml between September 2017 and August 2018 were included in the study. The patients were randomized into two groups: FWBG and CG, receiving fresh whole blood and component transfusions, respectively.ResultsA total of 65 patients with spinal deformities of different etiologies were included. The mean age was 14.0 and 14.9 years in FWB and CG, respectively. All other preoperative parameters were comparable. The mean fusion levels and surgical time were 11.1 and 221.20 min in FWB, as compared with 10.70 and 208.74minutes in CG, respectively. Intraoperative blood losses were 929 ml (FWBG) and 847 ml(CG), and the mean volumes of transfusion were 1.90 (FWBG) and 1.65 units (CG). FWBG was significantly superior to CG in the following clinical and laboratory parameters: duration of oxygen dependence [36.43 (FWBG) vs. 43.45 h (CG); P = 0.0256], mean arterial pH [7.442 (FWBG) vs. 7.394 (CG); p < 0.001], interleukin-6 [30.04 (FWBG) vs. 35.10 (CG); p < 0.019], mean duration of HDU stay [40.6 hours (FWBG) vs 46.51 hours (CG); p = 0.0234] and postoperative facial puffiness [7/30 in FWBG vs. 18/35 (CG) (P < 0.02)].ConclusionFWB transfusion can potentially improve the immediate postoperative outcome in patients undergoing major spinal deformity surgeries by reducing the duration of intensive care unit stay and oxygen dependence. The other potential benefits of this practice, based on our study, include a reduced inflammatory response (reduced lactate and IL-6) and postoperative facial puffiness. However, further large-scale validation studies in future are necessary to precisely determine the role of FWB in spine surgeries.Level of evidence IIDiagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Neurosurgery and artificial intelligence.

Neurosurgeons receive extensive and lengthy training to equip themselves with various technical skills, and neurosurgery require a great deal of pre-, intra- and postoperative clinical data collection, decision making, care and recovery. The last decade has seen a significant increase in the importance of artificial intelligence (AI) in neurosurgery. AI can provide a great promise in neurosurgery by complementing neurosurgeons' skills to provide the best possible interventional and noninterventional care for patients by enhancing diagnostic and prognostic outcomes in clinical treatment and help neurosurgeons with decision making during surgical interventions to improve patient outcomes. Furthermore, AI is playing a pivotal role in the production, processing and storage of clinical and experimental data. AI usage in neurosurgery can also reduce the costs associated with surgical care and provide high-quality healthcare to a broader population. Additionally, AI and neurosurgery can build a symbiotic relationship where AI helps to push the boundaries of neurosurgery, and neurosurgery can help AI to develop better and more robust algorithms. This review explores the role of AI in interventional and noninterventional aspects of neurosurgery during pre-, intra- and postoperative care, such as diagnosis, clinical decision making, surgical operation, prognosis, data acquisition, and research within the neurosurgical arena.

Visual acuity and its postoperative outcome after transsphenoidal adenoma resection

Transsphenoidal surgery (TSS) represents the gold standard of pituitary adenoma resection, providing a safe and minimal invasive treatment for patients suffering from symptoms of mass effect. The aim of this study is to analyze the postoperative improvement of visual function after adenoma resection and to identify prognostic factors for the postoperative clinical recovery. We performed a retrospective analysis of all consecutive patients treated via a transsphenoidal approach for pituitary adenomas from April 2006 to December 2019 in a high-volume neurosurgical department. Our primary outcome was postoperative visual acuity and visual field impairment; the clinical findings were followed up to 3 months after surgery and correlated with clinical and radiographic findings. In total, 440 surgeries were performed in our department for tumors of the sella region in a time period of 13 years via transsphenoidal approach, and 191 patients included in the analysis. Mean age was 55 years, and 98% were macroadenomas. Mean preoperative visual acuity in patients with preoperative impairment (n = 133) improved significantly from 0.64/0.65 to 0.72/0.75 and 0.76/0.8 (right eye R/left eye L) postoperatively and at 3 months follow-up (p < 0.001). Visual acuity significantly depended on Knosp classification but not Hardy grading. The strongest predictor for visual function recovery was age. Transsphenoidal pituitary tumor resection remains a safe and effective treatment in patients with preoperative visual impairment. It significantly improves visual acuity and field defects after surgery, and recovery continues at the 3 months follow-up examination.

Resting-state Amplitude of Low-frequency Fluctuation is a Potentially Useful Prognostic Functional Biomarker in Cervical Myelopathy.

Cervical MRI is the standard diagnostic imaging technique for patients with cervical myelopathy. However, the utility of conventional cervical MRI as a predictive biomarker for surgical recovery remains unclear, partly because of the limited information obtained from this anatomically small area. Brain resting-state functional MRI (rs-fMRI) may help identify candidate predictive biomarkers. Two analytical methods that assess local spontaneous brain activity are widely used for rs-fMRI: functional connectivity between two brain regions and amplitude of low-frequency fluctuation (ALFF). In our previous analysis of functional connectivity, we discovered that brain functional connectivity may be a predictive biomarker for neurologic recovery in patients with cervical myelopathy; however, the functional connectivity analysis identified a correlation with only one clinical outcome (the 10-second test). To establish a comprehensive prediction measure, we need to explore other brain biomarkers that can predict recovery of other clinical outcomes in patients with cervical myelopathy. We aimed to (1) elucidate preoperative ALFF alterations in patients with cervical myelopathy and how ALFF changes after surgery, with a focus on postoperative normalization and (2) establish a predictive model using preoperative ALFF by investigating the correlation between preoperative ALFF and postoperative clinical recovery in patients with cervical myelopathy. Between August 2015 and June 2017, we treated 40 patients with cervical myelopathy. Thirty patients met our prespecified inclusion criteria, all were invited to participate, and 28 patients opted to do so (93%; 14 men and 14 women; mean age: 67 years). The 28 patients and 28 age- and sex-matched controls underwent rs-fMRI (twice for patients with cervical myelopathy: before and 6 months after cervical decompression surgery). We analyzed the same study population that was used in our earlier study investigating functional connectivity. Controls had none of the following abnormalities: neck or arm pain, visual or auditory disorders, cognitive disorder, structural brain disorder, a history of brain surgery, mental and neurologic disorders, and medications for the central nervous system. We performed ALFF comparisons between preoperative patients with cervical myelopathy and controls, analyzed postoperative ALFF changes in patients with cervical myelopathy, and performed a correlation analysis between preoperative ALFF and clinical recovery in these patients. Clinical outcomes in the cervical myelopathy group were assessed using the 10-second test, the Japanese Orthopaedic Association upper-extremity motor (JOA-UEM) score, JOA upper-extremity sensory score (JOA-UES), and Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire for upper-extremity function (JOACMEQ-UEF) score before and 6 months after surgery, which is when we believe these scores generally reach a plateau. A total of 93% of those enrolled (26 of 28 patients) were analyzed both preoperatively and postoperatively; the other two were lost to follow-up. The cervical myelopathy group had an increase in ALFF in the bilateral primary sensorimotor cortices (right, cluster size = 850 voxels, t-value = 6.10; left, cluster size = 370 voxels, t-value = 4.84) and left visual cortex (cluster size = 556 voxels, t-value = 4.21) compared with the control group. The cervical myelopathy group had a decrease in ALFF in the bilateral posterior supramarginal gyrus (right, cluster size = 222 voxels, t-value = 5.09; left, cluster size = 436 voxels, t-value = 5.28). After surgery, the bilateral sensorimotor cortices (right, cluster size = 468 voxels, t-value = 6.74; left, cluster size = 167 voxels, t-value = 5.40) and left visual cortex (cluster size = 3748 voxels, t-value = 6.66) showed decreased ALFF compared with preoperative ALFF, indicating postoperative normalization of spontaneous brain activities in these regions. However, the bilateral posterior supramarginal gyrus did not show an increase in ALFF postoperatively, although ALFF in this region decreased preoperatively. Greater levels of ALFF at the left and right frontal pole and left pars opercularis of the inferior frontal gyrus before surgery in the cervical myelopathy group were correlated with larger improvements in the JOACMEQ-UEF score 6 months after surgery (r = 0.784; p < 0.001, r = 0.734; p < 0.001 and r = 0.770, respectively; p < 0.001). The prediction formula, based on preoperative ALFF values in the left frontal pole, was as follows: the predicted postoperative improvement in the JOACMEQ-UEF score = 34.6 × preoperative ALFF value - 7.0 (r = 0.614; p < 0.001). Our findings suggest that preoperative ALFF may be a biomarker for postoperative recovery in that it predicted postoperative JOACMEQ-UEF scores. To establish a comprehensive prediction measure for neurologic recovery in patients with cervical myelopathy, a multicenter study is underway. Level II, diagnostic study.

Posteromedial quadratus lumborum block versus transversus abdominal plane block for postoperative analgesia following laparoscopic colorectal surgery: A randomized controlled trial

Study objectiveOur hypothesis was that a pre-operative posteromedial quadratus lumborum (QL) block would reduce postoperative morphine consumption and provide superior analgesia in the setting of multimodal analgesia compared with a lateral transversus abdominis plane (TAP) block for laparoscopic colorectal surgery. DesignA randomized controlled study. SettingA single tertiary hospital. March to August 2018. Patients80 ASA I–II colorectal cancer patients undergoing laparoscopic radical resection were enrolled. 77 patients (group QL 38, group TAP 39) were included in the analysis. InterventionPre-operatively, patients were randomized to receive either a QL or TAP block (0.375% ropivacaine 20 ml bilaterally for each group). MeasurementsThe primary outcome was cumulative morphine consumption 24 h postoperatively. Secondary outcomes included postoperative pain scores, clinical recovery, and side-effect profiles of the blocks. Main resultsFor the primary outcome measure, morphine consumption 24 h postoperatively was significantly lower in the QL group than in the TAP group (estimated median difference −8 mg, adjusted 95% confidential interval −12 to −6 mg, P < 0.001). The pain visual analogue scores at rest and during movement were found to be statistically significantly lower in the QL group than in the TAP group 8, 12, and 24 h postoperatively (P < 0.006). The QL group reported higher overall satisfaction scores regarding postoperative analgesia than the TAP group (P = 0.014). One patient in the QL group experienced moderate back pain close to the needle entry site postoperatively. There was no statistically significant difference in postoperative nausea and vomiting, bowel recovery or length of hospital stay between the groups. ConclusionsThe pre-operative bilateral, ultrasound-guided posteromedial QL block reduces morphine consumption and improves analgesia in the setting of multimodal analgesia compared with the lateral TAP block after laparoscopic colorectal surgery.

Ventral slot in the clinical recovery of dogs with lateralized compression as a result of cervical intervertebral disc disease - 20 cases (2008-2018)

ABSTRACT: The objective of this study was to verify the clinical recovery of dogs that underwent ventral slot surgical decompression with lateralized compressions of the cervical spinal cord caused by intervertebral disc disease (IVDD). Twenty patients were selected in different degrees of neurological dysfunction with definitive diagnosis of lateralized compression by cervical IVDD. Postoperative clinical recovery was assessed in patients who had undergone at least two months of the surgical procedure. There was a satisfactory recovery in 19 dogs (95%) and unsatisfactory recovery in another (5%), showing a significant clinical improvement (p&lt;0.05) in the use of this technique in lateralized compression cases. The ventral slot promotes satisfactory clinical recovery of dogs with lateralized compression of the spinal cord caused by cervical IVDD and may be indicated as a surgical alternative.

Atlantoaxial Fixation for Treatment of Chiari Formation and Syringomyelia with No Craniovertebral Bone Anomaly: Report of an Experience with 57 Cases.

In this paper we evaluate the role of atlantoaxial instability in the pathogenesis of Chiari formation typeI and the role of atlantoaxial stabilization for treatment of this condition in cases with no obvious bone malformation in the region of the craniovertebral junction. During the period from January 2010 to July 2016, we identified 57 cases of Chiari formation where there was no bone malformation or evidence of craniovertebral junction instability that could be diagnosed on the basis of an abnormal increase in the atlantodental interval on dynamic imaging. Forty-eight of these patients had syringomyelia. The average duration of follow-up was 42months. There were 30 males and 27 females in the series. The ages of the patients ranged from 4 to 57years. The Japanese Orthopaedic Association (JOA), visual analogue scale (VAS) and Goel clinical grading systems were used to assess the patients' clinical status. Atlantoaxial instability was diagnosed on the basis of vertical mobility of the odontoid process on dynamic radiographs, facetal malalignment on imaging or direct bone handling during the surgical procedure. Surgical treatment was achieved using atlantoaxial fixation. Foramen magnum decompression or syrinx manipulation was not done. All patients had immediate postoperative and sustained clinical symptomatic recovery. A reduction in the size of the syrinx was observed in ten patients and regression of tonsillar herniation was observed in 12 of 23 cases in which postoperative magnetic resonance imaging (MRI) was possible. Atlantoaxial instability is the prime factor in the genesis of Chiari formation even when there is no bone abnormality in the craniovertebral junction.

Prolonged air leak after video-assisted thoracic surgery lung cancer resection: risk factors and its effect on postoperative clinical recovery.

Prolonged air leak (PAL) is one of the most common postoperative complications after pulmonary resection. The aim of this study was to reveal the incidence and risk factors of PAL in video-assisted thoracic surgery (VATS) lung cancer resection, and to evaluate the effect of PAL on postoperative complications, postoperative length of stay (PLOS), and medical costs. Continuous patients who underwent VATS major pulmonary resection for lung cancer between January 2014 and December 2015 were studied. Clinical data of these patients were obtained from the Western China Lung Cancer Database. PAL was defined as air leak more than 5 days after surgery. The risk factors for PAL were analyzed, as well as the effect of PAL on postoperative clinical recovery. A total of 1,051 patients were enrolled in this study. The incidence of PAL was 10.6% (111/1,051). Pleural adhesion [odds ratio (OR), 2.38 for extensive vs. none, P=0.001] was identified as the only independent risk factors for PAL through multivariate analysis. The incidence of overall complications and pneumonia were significantly higher in patients with PAL (PAL group) than those without PAL (non-PAL group) (OR, 6.77, P=0.000; OR, 2.41, P=0.010, respectively). PAL was found to be associated with longer PLOS (11.7±6.6 vs. 6.5±3.6 days; P=0.000) and higher medical costs (¥62,042.5±18,072.0 vs. ¥52,291.3±13,845.5, P=0.000). Pleural adhesion was associated with increased risk of PAL after VATS lung cancer resection. Those patients with PAL had more postoperative complications, stayed longer in the hospital after surgery, and paid higher medical costs.

CORR Insights®: Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network.

CORR Insights®: Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network.

Impact of long-term soft contact lens wear on epithelial flap production and postoperative recovery in laser-assisted subepithelial keratomileusis.

To investigate the impact and postoperative clinical recovery of long-term soft contact lens wear on the epithelial flap made during laser-assisted subepithelial keratomileusis (LASEK). In a prospective study, 371 patients (589 eyes) who underwent LASEK were divided into four groups (G1, G2, G3, G4) according to their length of soft contact lens wear. After the contact lens (CL) was removed 1 week after surgery, various symptoms - uncorrected visual acuity (UCVA), oedema of the corneal epithelium, spherical equivalent (SE) and haze degree - were recorded on day 1, and at 1 and 3 months postoperatively. There were no significant differences in corneal flap production among the first three groups that wore CLs, but various symptoms and UCVA were all different from the fourth group that did not wear CLs. There were statistically significant differences in oedema of corneal epithelium among the first three groups, and the degree of oedema was positively correlated with the CL wearing time. There were no significant differences in postoperative SE and haze in all four groups. Long-term soft CL wear can affect production of the epithelial flap and postoperative recovery, including various symptoms, oedema of the central corneal epithelium and visual acuity. In contrast, there was no effect of long-term CL wear on postoperative mean refractive spherical equivalent (MRSE) and haze.

Minimally invasive endoscopic ulnar nerve assessment and surgery for cubital tunnel syndrome patients—Relation between endoscopic nerve findings and clinical symptoms

To minimize damage to healthy tissues, we have been performing endoscopically assisted cubital tunnel syndrome surgery based on endoscopic nerve findings since 1995. This is the first study to focus on endoscopic surgery for cubital tunnel syndrome based on endoscopic ulnar nerve findings and the subsequent postoperative clinical results. We analysed 82 upper extremities of 74 cubital tunnel syndrome patients who had undergone endoscopically assisted release surgery using the Universal Subcutaneous Endoscope system. Endoscopic observations of the ulnar nerve were made from a single 1- to 3-cm endoscopic portal incision at the cubital tunnel to 10 cm proximal and 10 cm distal. The abnormal nerve areas were identified and released based on nerve degeneration findings under endoscopic observation. The abnormal areas spread eccentrically from the entrapment point(s). In 82 diseased upper extremities, ulnar nerve entrapment occurred at the cubital tunnel. However, one extremity suffered from entrapment at the arcade of Struthers' in addition to the cubital tunnel. All patients showed improved clinical symptoms following surgery. There is no statistical relation between pre- and postoperative clinical scores of Dellon's Staging and abnormal nerve length findings. Cubital tunnel syndrome is usually caused by entrapment at the cubital tunnel; however, in some cases, there are other point entrapment(s). Our endoscopically assisted procedure avoids any damage to healthy tissues because the surgeon can observe the entrapment point(s) prior to release. Postoperative clinical recovery results clearly indicate that endoscopic nerve findings reveal entrapment points and ulnar nerve degeneration can spread maximally 10 cm distally and proximally from the entrapment point(s), even in clinically mild severity cases. All other possible entrapment points should, therefore, be observed and released using our procedure.