Postoperative Interval Research Articles

Clinical application of a multi-groove silicone drain combined with unidirectional negative-pressure drainage system in single-operating-port video-assisted thoracoscopic lung cancer surgery: a comparison study.

ObjectiveTo evaluate the effect of a new negative-pressure drainage system in thoracoscopic lung cancer surgery; thereby, providing a new option for postoperative drainage.MethodsWe retrospectively analyzed data for 200 patients who underwent thoracoscopic surgery between May 2018 and October 2019. According to the thoracic drainage method, the patients were divided into the thoracic tube group and the new system group. The epidemiological and clinicopathological data were compared before operation, and the clinical effect of thoracic drainage was compared after operation.ResultsThere was no significant difference in epidemiological and clinicopathological data between the two groups. There was also no significant difference in drain removal time, hospital stay, and complication rates between the two groups. However, the incidences of pleural effusion and poor incision healing in the new system group were lower than in the thoracic tube group. Visual analog scale (VAS) scores in the new system group were lower than those in the thoracic tube group at each postoperative interval; therefore, the new system group required less analgesia.ConclusionThe new system was not inferior to thoracic tubes regarding the drainage effect after thoracoscopic lung cancer surgery. Hence, the system is an alternative to traditional thoracic tubes.

Evaluation of bone gain and implant survival after vertical and horizontal ridge augmentation using titanium mesh with simultaneous implant placement in deficient maxillary and mandibular ridge: A prospective clinical study

The present clinical study was conducted with a one-stage approach for alveolar ridge augmentation using titanium mesh with simultaneous implant placement in the compromised ridges. This prospective study included a total no. of 26 partially edentulous sites which were treated with implants and simultaneous guided bone regeneration with titanium mesh. We found a significant increase in the bucco-lingual width at implant site when comparison was made at different time intervals. We found a significant decrease in the mean bone density on the mesial side (1934.62 ± 598.26 gray units), while no significant decrease in the mean bone density was found on the distal side ( 1873 ± 576.12 gray units) when compared at immediate post-operative and 6-months post-operative time interval. Despite the use of micropore titanium mesh, we have noticed membrane exposure in 10 patients (71.42%) among 14 patients which resulted in detrimental influence on the amount of bone augmentation. The bucco-lingual width of the alveolar crest has been significantly increased, but we couldn’t achieve any optimal gain in alveolar crest height.

An evaluation of the effect of ozone therapy on tissues surrounding dental implants

BackgroundDental implant surgery despite its growing popularity poses several challenges like include tissue inflammation, pain discomfort and tissue injury. ObjectiveTo evaluate the effect of ozone therapy on inflammation, pain and wound healing after implant surgery. MethodsA clinical study was conducted on 60 systematically healthy patients- 30 patients treated with ozone (Experimental group) and 30 patients without ozone treatment (control group). In the control group osteotomy procedure was performed with saline irrigation and in the experimental group irrigation was done with ozonated water at 25 µg/mL concentration, along with ozone gas. Clinical assessment was done by evaluating C-reactive Protein (CRP) for inflammation, pain using Visual Analogue Scale (VAS) score and tissue wound healing using wound healing index. Side effects, if any, were noted. ResultsPostoperative increment in CRP levels was 0.10 and 0.63 mg/dl in Experimental and control groups respectively (p < 0.001). At 24-hr, 48-hr and 7 day post-operative intervals mean VAS scores for pain were significantly higher in Control group as compared to that in Experimental Group (p < 0.001). At day 7, mean VAS scores for pain were 3.50 ± 0.63 and 37.70 ± 4.17 in Experimental and Control groups respectively (p < 0.001). Mean tissue healing indices were significantly higher on Day 7 and Day 14 in Experimental Group (4.23 ± 0.43 and 4.97 ± 0.18) as compared to that in control group (3.07 ± 0.45 and 4.03 ± 0.18) (p < 0.001). No potential side effects were noted in either of two groups. ConclusionOzone therapy accelerated the tissue wound healing, minimized tissue inflammation and decreased pain.

Epilepsy surgery: Late seizure recurrence after initial complete seizure freedom.

This study was undertaken to improve understanding of late relapse following epilepsy surgery in pharmacoresistant epilepsy. Retrospective comparison was made of 99 of 1278 patients undergoing surgery during 1999-2015 with seizure relapses after at least 2years of complete seizure freedom with matched controls experiencing continued long-term seizure freedom. Univariate and multivariate analyses were performed. With a mean follow-up of 9.7years, mean time to seizure relapse was 56.6months. In multivariate analysis, incomplete resection based on magnetic resonance imaging (MRI), bilateral lesions on preoperative MRI, and epilepsy onset in the first year of life carried a significantly higher risk of late relapse. In patients with late relapse, additional functional imaging with positron emission tomography had been performed significantly more often. Although the differences were not significant in multivariate analysis, doses of antiepileptic drugs were higher in the relapse group preoperatively and in the first 24months and complete withdrawal was more frequent in the control group (68% vs. 51%). Regarding seizure frequency, most patients had mild seizure relapse (single relapse seizure or <1/month). In our predominantly lesional cohort, complete resection of the MRI lesion is the most important factor to maintain long-term seizure freedom. Two patterns of recurrence were identified: (1) incomplete resected lesions with seizure generation in proximity to the initial resection and (2) epileptogenic networks not detected preoperatively or evolving in the postoperative interval and manifesting with new clinical and diagnostic features.

Treatment of Donor-Specific Antibody Mediated Rejection after Heart Transplantation by IGM-Enriched Human Intravenous Immunoglobulin

Purpose Representing a rare complication, antibody-mediated graft rejection (AMR), particularly caused by donor-specific antibodies (DSA), remains a serious problem after heart transplantation (HTx). Plasmapheresis, application of rituximab as well as intravenous immunoglobulins (IVIG) are widely established, however often insufficient treatments for AMR. IgM-enriched human intravenous immunoglobulin (IGM-IVIG) consists of IgM, IgA and IgG and provides a new multifactorial approach to the immunologic cascade of DSA-mediated AMR, however its efficiency is by now still not clear. Methods Between 2017 and 2020 four patients (P 1-4) developed DSA-mediated rejection (DSA-MR) after HTx in our department and were repetitively treated with 0.5-1.0 g/kg body weight IGM-IVIG (Pentaglobin®, Biotest AG, Dreieich, Germany) in combination with 3.0 mg/kg body weight anti-thymocyte globulin (ATG). Results Patients were transplanted at the age of 47 (P1), 57 (P2), 30 (P3) and 68 years (P4). Except P2, all patients were male. While in P1 and P4, DSA-MR occurred within the early postoperative interval after HTx, P2 and P3 developed DSA-MR one year after transplantation. In all patients donor-specific HLA-antibodies were found, however pathological examinations of right ventricular biopsies could only confirm AMR in P1-3 (pAMR1° to pAMR3°) but not in P4 (pAMR0). A severe impairment of biventricular function was observed in all patients with need for temporary veno-arterial extracorporeal membrane oxygenation (va-ECMO) in P4. Furthermore, P1 and P4 suffered from malign ventricular arrhythmias. After repetitive application of IGM-IVIG all patients could be stabilized, ventricular function recovered, and P1-3 could be discharged from hospital and are still alive today, whereas P4 has been transplanted quite recently and is still recovering in hospital. Conclusion DSA-MR provokes serious complications affecting the outcome after HTx. By application of IGM-IVIG, we were able to successfully treat all of our four patients suffering from severe graft failure caused by DSA-MR and no patient developed treatment-related adverse effects. As part of a multifactorial therapeutic approach, pharmacological treatment with IGM-IVIG seems to be a safe and effective strategy in order to address DSA-MR and offers promising results for the future.

Evolving Patient Perception of Limb Length Discrepancy Following Total Hip Arthroplasty

BackgroundLimb length discrepancy (LLD) is a known complication of total hip arthroplasty (THA), leading to decreased patient function and satisfaction. It remains unknown how a patient’s perception of LLD evolves over time. The aim of this study is to evaluate the relationship between measured and perceived LLD, and to assess whether perceived LLD resolved with time in most patients. MethodsThis study retrospectively reviewed radiographs of 140 consecutive patients undergoing primary THA by a single surgeon via a direct anterior approach, calculating postoperative change in limb length (ΔL). Patient perceptions of LLD were recorded at standard postoperative visit intervals. A P-value of .05 was used to determine statistical significance. ResultsOf 130 patients (mean ΔL = +7.9 mm), 22 patients endorsed perceived postoperative LLD and the remainder were asymptomatic (mean ΔL +11.1 mm vs +7.3 mm, P = .03). Seventeen patients reported mild symptoms and 5 reported severe symptoms (mean ΔL +10.2 mm vs +13.8 mm, P = .4). After 1 year, 45% (10) patients reported complete resolution of perceived LLD (mean follow-up 364 days), 18% (4) reported notable improvement, and 36% (8) reported no improvement. Four excluded patients endorsed perceived LLD (2 mild, 2 severe), which resolved after contralateral THA. ConclusionThis study noted a correlation between increasing postoperative ΔL and perceived LLD. A majority of patients (63%) experienced either improvement or full resolution of symptoms during the follow-up period. This data may have a role in reassuring the orthopedic surgeon and the patient regarding the natural course of postoperative LLD. Further investigation is needed to help identify risk factors for persistent LLD. Level of EvidenceLevel III (Prognostic).

Comparative Study Among Ketamine, Fentanyl, and Ropivacaine, as Pre-incisional Analgesic Given by Surgical Site Infiltration, in Cases Posted for Elective Lower Segment Cesarean Section Under General Anesthesia.

AimThe aim of this study was to evaluate the effect of surgical site infiltration prior to giving incision, with ketamine, fentanyl, and ropivacaine, on perioperative hemodynamic parameters, pain, and any adverse outcomes.MethodsThe study was carried out on 68 patients divided into four groups of 17 each. After intubation, the study drug was infiltrated subcutaneously at the surgical site, seven min before incision, by the surgeon who was unaware of the injectate. Hemodynamic variables were monitored and recorded during the intraoperative period and postoperative period at one, two, four, six, eight, 12, and 24 hours. The level of sedation was assessed using the Ramsay sedation score (RSS). The fetal outcome was assessed by the APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score at one, five, and 10 minutes.ResultsThe mean visual analog scale (VAS) scores were significantly (p < 0.05) lower in group A as compared to other groups for most of the postoperative period. Hemodynamic stability was also significantly better with group A as compared to other groups during the perioperative period. The fetal outcome was comparable between the study groups with the APGAR scores similar between the groups at 10 min. However, significantly lower APGAR values were seen in group C as compared to the other study groups, at one and five minutes.ConclusionKetamine infiltration resulted in a better hemodynamic profile, a significantly longer duration of the postoperative pain-free interval, and more sedation in the postoperative anesthesia care unit (PACU). It did not affect the fetal wellbeing, as discernable from the APGAR scores.

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

PurposeTo evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW-DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications.MethodsSeventy-nine consecutive patients with a mean age of 47 ± 12 years who underwent LCW-DFO for symptomatic varus malalignment at the authors’ institution between 01/2007 and 03/2018 with a minimum of 2-year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior–posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted.ResultsThe incidence of medial cortical hinge fractures was 48%. The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%). An increased length of the osteotomy in mm (53.1 ± 10.9 vs. 57.7 ± 9.6; p = 0.049), an increased height of the excised wedge in mm (6.5 ± 1.9 vs. 7.9 ± 3; p = 0.040) as well as a hinge location in the medial sector of an established sector grid (p = 0.049) were shown to significantly predispose for the incidence of a medial cortical hinge fracture. The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone > 2 mm (p < 0.05).ConclusionMedial cortical hinge fractures after LCW-DFO are a common finding. An increased risk of sustaining a hinge fracture has to be expected with increasing osteotomy wedge height and a hinge position close to the medial cortex. Furthermore, dislocation of a medial hinge fracture > 2 mm was associated with malunion and should, therefore, be avoided.Level of evidencePrognostic study; Level IV.

Medial canthopexy using mini-screws &/or micro plates for the surgical treatment of post traumatic telecanthus associated with naso-orbito-ethmoidal fractures

BackgroundThe normal bony insertion of the medial canthal tendon can be disrupted after trauma, as a result of ablative surgery or as a consequence of subperiosteal detachment during a craniofacial surgical procedure. Medial canthoplasty is required to avoid telecanthus following these events. Several surgical techniques have been described to reattach the tendon to the posterior lacrimal crest. The techniques of transnasal wiring had been used widely to reconstruct medial canthal tendon. However, some surgeons have preferred the use of ipsilateral techniques that include the nylon anchor suture, the stainless-steel screw and/or miniplates. Aim of the studyThis study aims to present a technique for Canthopexy and Medial canthal ligament reconstitution secondary to posttraumatic medial canthal degloving injuries using mini-screws and/or microplates to obtain a consistent and definitive reinforcement of the Medial Canthal ligament and its continuity to the postero-superior surface of the medial orbital wall. Materials and methodsThe present study enrolled 23 patients with posttraumatic medial telecanthus deformity that had been treated over a 3-year period from July 2016–June 2019. Clinical examination had been scheduled for all patients regarding evaluation of lacrimal system function, medial canthal position in addition to eyelid measurements. Visual impairment and movements of the eye were evaluated by ophthalmological consultation. Irrigation and probing were used for evaluation of the nasolacrimal system. MCT detachment can be determined by Bowstringing test through subcutaneous palpation of the MCT as one stretches the lid laterally.Eyelid evaluation comprised recording measurements of the inter-canthal distance (ICD), the interpupillary distance (IPD) and the palpebral fissure length (PFL). Telecanthus was assessed by recording the distance (in millimetres) measured between the facial midline and the medial canthus of the injured eye that will be compared to the corresponding values of the uninjured eye preoperatively and at all postoperative follow-up intervals. Radiographic assessment was evaluated by axial, coronal and sagittal C.T scans preoperatively and at 1, 3 and 6 months postoperatively. ResultsMedial Canthopexy with mini-screws was performed in 15 patients while a Y-shaped micro plate was utilized in 8 patients. The postoperative medial canthal position had been reported to be satisfactory in all patients, showing a considerable improvement compared with the preoperative position. The patients were re-evaluated at 1,3 and 6 months postoperatively demonstrating absence of any evidence of recurrence and with an acceptable cosmetic result, as the medial canthal concavity had been successfully achieved. All patients were satisfied except one that was overcorrected and re-operated for re correction. Another one was under corrected and had undergone revision. However, at 6 weeks postoperatively, one patient had a wound dehiscence resulting in medial canthal detachment and required retreatment. In all patients (except for the one of wound dehiscence), the post-canthopexy Bow String test failed to cause loss of canthal re-attachment and reconstruction or even lateral displacement of the medial canthal tendon throughout all the follow-up intervals. ConclusionsMedial Canthopexy using mini-screws and/or microplates is a simple, easy and reliable technique for the surgical correction of posttraumatic Telecanthus secondary to MCT detachment as this technique promotes satisfactory post-surgical outcomes with resultant acceptable esthetic and functional results.

The Perioperative Symptom Severity of Higher Patient Health Questionnaire-9 Scores Between Genders in Single-Level Lumbar Fusion.

Preoperative depression is associated with increased perioperative pain, worse physical function, reduced quality of life, and inferior outcomes. Few studies have evaluated depressive symptoms between genders for individuals undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). The purpose of this investigation was to assess the severity of Patient Health Questionnaire-9 (PHQ-9) scores among patients with depressive symptoms before and after single-level MIS TLIF. A prospective surgical registry was retrospectively reviewed for spine surgeries between March 2016 and December 2018. We included patients with at least mild depressive symptoms (PHQ-9 scores ≥ 5) who underwent primary, single-level MIS TLIF and compared genders using χ2 tests and t tests. Genders were stratified by depressive symptom severity: mild (5-9), moderate (10-14), and moderately severe (≥15) and then analyzed at preoperative and postoperative intervals: 6 weeks, 12 weeks, 6 months, and 1 year. Finally, PHQ-9 scores were validated with a Pearson correlation test against the 12-item Short Form (SF-12) Mental Composite Score (MCS) and the Veterans RAND (VR-12) MCS. Of 75 subjects, 44.0% were women and the mean age was 49.9 years. The preoperative distribution among PHQ-9 subgroups was 38.7%, 26.6%, and 34.7% for mild, moderate, and moderately severe depressive symptoms, respectively. Among PHQ-9 stratifications both genders demonstrated intermittent statistically significant improvements in PHQ-9 scores. The moderately severe PHQ-9 subgroup had improvement at all postoperative time points. The PHQ-9 scores demonstrated a strong correlation with the SF-12 MCS and VR-12 MCS at all postoperative evaluations. At baseline and by the final 1-year follow-up there were no statistically significant PHQ-9 score differences between genders within any depressive symptom stratifications. Whereas some contend that men and women have substantial mental health differences, this study is aligned with growing evidence that demonstrates similar depressive symptoms between genders. 3. Men and women may be at an equivalent risk for perioperative depressive symptoms.

Clinical impact of postoperative interval until adjuvant chemotherapy following curative gastrectomy for advanced gastric cancer.

Background: Adjuvant chemotherapy (AC) following curative gastrectomy for stage II/III gastric cancer (GC) is recommended in Japan. However, for various reasons, patients cannot always start AC at the appropriate time. This study was designed to investigate the effect of the postoperative interval until adjuvant chemotherapy (PIAC) and cumulative S-1 dose on prognosis.Methods: Between 2008 and 2014, consecutive 81 GC patients who underwent postoperative S-1 monotherapy were enrolled in this study.Results: Postoperative complications of Clavien-Dindo grade II or higher and postoperative peak C-reactive protein of 8.1 mg/dl or higher were significantly associated with delayed AC. The cut-off value of PIAC selected to most effectively stratify prognosis was 7 weeks. For relapse-free survival (RFS), patients with PIAC ≥ 7 weeks had an insignificantly poorer prognosis than those with PIAC < 7 weeks. A multivariate analysis showed that PIAC ≥ 7 weeks [p = 0.024; hazard ratio (HR) 2.45] and the cumulative S-1 dose/body surface area (BSA) ≥ 12,000 mg/m2 [p = 0.004; HR 3.27] were independent prognostic factors. In patients with the cumulative S-1 dose/BSA ≥ 12,000 mg/m2, there were no prognostic differences between patients with and without PIAC ≥ 7 weeks.Conclusions: Seven weeks after surgery could be a limit indicator starting AC. A cumulative S-1 dose/BSA of more than 12,000 mg/m2 might be a key dose for diminishing the poor prognostic effects of delaying AC.

Prospective Assessment of the Abdominal Hernia-Q (AHQ)-Patient Burden, Reliability, and Longitudinal Assessment of Quality of Life in Hernia Repair.

This study assesses the user burden, reliability, and longitudinal validity of the AHQ, a novel VH patient-reported outcomes measure (PROM). We developed and psychometrically validated the AHQ as the first VH-specific, stakeholder-informed PROM. Yet, there remains a need to assess the AHQ's clinical applicability and further validate its psychometric properties. To assess patient burden, pre- and postoperative patients were timed while completing the corresponding AHQ form. To measure test-retest reliability, a subset of patients completed the AHQ within a week of initial completion, and consecutive responses were correlated. Lastly, patients undergoing VH repair were prospectively administered the pre- and postoperative AHQ forms, the Hernia-Related Quality of Life Survey and the Short Form-12 both preoperatively and at postoperative intervals, up to over a year after surgery. Quality-of-Life scores were correlated from the 3 PROMs and effect sizes were compared using analysis of normal variance. Median response times for the pre- and postoperative AHQ were 1.1 and 2.7 minutes, respectively. The AHQ demonstrates high test-retest reliability coefficients for pre- and postoperative instruments ( r = 0.91, 0.89). The AHQ appropriately and proportionally measures expected changes following surgery and significantly correlates with all times points of theHernia-Related Quality of Life Survey and Short Form-12 MS and 4/5 (80%) SF12-PS. The AHQ is a patient-informed, psychometrically-validated, clinical instrument for measuring, quantifying, and tracking PROMs in VH patients. The AHQ exhibits low response burden, excellent reliability, and effectively measures hernia-specific changes in quality-of-Life following ventral hernia repair.

Onlay versus inlay reverse total shoulder arthroplasty: a retrospective comparison of radiographic and clinical outcomes

IntroductionRecent innovations in reverse shoulder arthroplasty (RSA) have presented 2 distinct humeral stem designs: an onlay system that rests above the anatomic neck and an inlay component that rests within the metaphysis. The purpose of this study is to compare clinical and radiographic outcomes between inlay and onlay-designed humeral stems in lateral center of rotation RSA implant systems. MethodsA retrospective cohort study was performed on primary RSA patients treated by 2 surgeons at 2 separate hospitals with a minimum 2-year follow-up. Patients were categorized based on treatment with an onlay or inlay humeral design and matched 1:1 by indication and age. Patient-reported outcome measures (PROMs), including the Simple Shoulder Test, American Shoulder and Elbow Surgeons, and Visual Analog Score for pain, as well as active motion (forward elevation, internal rotation) were recorded at pre- and postoperative intervals. An Inlay-Onlay index assessed the degree of inset or offset of each particular implant referencing the anatomic neck. Radiographic analysis focused on scapular notching, bone resorption around the humeral stem, and acromion stress fractures. ResultsA total of 92 patients participated in the 1:1 matched analysis (46 each group). Cohorts were similar in age, gender, indication, follow-up length, and preoperative PROMs, with the exception of Simple Shoulder Test. At the most recent follow-up, there were no differences in all PROMs between groups. There were no differences in active internal rotation, but patients with an onlay-configuration demonstrated greater external rotation (P< .001) and forward flexion (P< .001). Greater tuberosity and calcar resorption occurred in 34 (74%) and 18 (39%) patients with an onlay-designed prosthesis, compared to 13 (28%) and 1 (2%) in the inlay group, respectively (P< .0001). Both groups had low rates of scapular notching (P= 1.0), while acromial fractures occurred in 6 patients with an onlay stem and in 4 patients with the inlay stem (P= .73). ConclusionThere were no differences in clinical outcomes or incidence of acromial fractures following RSA with an onlay- or inlay-style humeral stem prosthesis. Bone resorption of the proximal humerus occurred more frequently in patients with an onlay prosthesis, suggesting that an inlay prosthesis may afford better prevention of humeral stress shielding. Level Of EvidenceLevel III; Retrospective Comparative Study

Improvement in Snoring and Sleep Apnea after Adenotonsillectomy in Children of 3 To 10 Years of Age

Background: Variability is found about the severity of upper airway obstruction ranging from primary snoring to obstructive sleep apnea syndrome (OSAS). Adenotonsillectomy (AT) is taken as the primary treatment option. Objective: To evaluate the efficacy of Adenotonsillectomy among children having obstructive sleep apnea syndrome. Methodology: This was a cross-sectional study conducted at Bahawal Victoria Hospital Bahawalpur from January 2017 to January 2018. A total of 52 children of both genders, aged 3 to 10 years, having obstructive sleep apnea syndrome (OSAS) and selected for Adenotonsillectomy (AT) were enrolled. Adenotonsillectomy was performed in all the study participants employing general anesthesia. Preoperative and postoperative characteristics as well as respiratory and sleep parameters were compared adopting chi-square test for qualitative variables while t-test was employed for quantitative variables. Results: Out of a total of 52 children, 32 (61.5%) were male. The majority of the children, 27 (51.9%) were between 3-6 years of age. Statistically significant improvement (p-value &lt; 0.05) was noted at the postoperative interval following AT for obstructive AHI score, respiratory disturbance index, obstructive apnea and hypopnea index, SpO2 nadir, TSpO2&lt;90%, and respiratory arousal index. Obstructive AHI score &lt; 1 episode / hour was seen in 37 (71.2%) children while AHI score &lt; 5 episodes / hour were noted in 47 (90.4%). Conclusion: Adenotonsillectomy for obstructive sleep apnea syndrome improved quality of life and polysomnographic parameters in most of the children.

Examining Preoperative Expectations and Postoperative Satisfaction in Rhinoplasty Patients: A Single-Center Study.

Background: In Rhinoplasty, understanding patient expectations are pivotal in achieving an optimal surgical outcome. Objective: To understand preoperative expectations and postoperative satisfaction in patients undergoing rhinoplasty for functional, aesthetic, or both. Method: Adult patients undergoing functional, aesthetic, or combined rhinoplasty from March 2017 to June 2019 were prospectively enrolled. Only patients with complete preoperative functional and cosmetic expectation visual analog scales (VAS) and at least one postoperative functional and cosmetic satisfaction VAS were included. Nasal Obstruction and Symptom Evaluation Scale score and Standardized Cosmesis and Health Nasal Outcomes Survey score were also collected. Results: In the functional subgroup (mean preoperative functional expectation VAS score [17.98 (22.49)] higher mean (standard deviation) postoperative functional satisfaction VAS score were observed at postoperative time interval <2 months [29.59 (27.08), p = 0.008] and 8-12 months [31.43 (28.25), p = 0.035]. In the aesthetic subgroup mean preoperative cosmetic expectation VAS score [89.69 (17.74)], lower mean postoperative aesthetic satisfaction VAS scores were observed at <2 months [79.09 (20.01), p = 0.0001], 2-5 months [79.79 (20.79), p = 0.032], 5-8 months [72 (18.27), p < 0.0001], 8-12 months [78.15 (24.50), p = 0.021], and >12 months [75 (20.64), p = 0.00020]. In the combined subgroup (mean preoperative aesthetic expectation VAS score [85.85 (18.19)]), lower mean postoperative aesthetic satisfaction VAS scores were observed at 2-5 months [78.94 (20.88), p = 0.01] and at >12 months [75.86 (25.57), p = 0.01]. Conclusion: Although rhinoplasty patients tend to be less satisfied with aesthetic than the functional outcome of surgery, preoperative aesthetic expectations are higher in cosmetic rhinoplasty and functional and cosmetic rhinoplasty patients.

Early clinical and radiographic results of reverse shoulder arthroplasty with press-fit metaphyseal humeral fixation

BackgroundReverse shoulder arthroplasty (RSA) has seen a recent transition from cemented to press-fit humeral stems. Several press-fit designs have focused on proximal fixation, yet there remains a paucity of data on their performance. The purpose of this study is to report early radiographic and clinical results of a third-generation RSA system, featuring metaphyseal porous metal fixation. MethodsA retrospective review was performed on primary RSA patients treated with a single third-generation standard-length implant system incorporating proximal osteointegration features with a minimum 2-year follow-up. Patient-reported outcome measures, including the Simple Shoulder Test, American Shoulder and Elbow Surgeons, Visual Analog Scale for pain, and Single Assessment Numeric Evaluation, as well as measured active motion (forward elevation, external, and internal rotation) were recorded at pre- and postoperative intervals. Immediate postoperative radiographs were used to measure filling ratios at the epiphyseal, metaphyseal, and diaphyseal levels. Most recent radiographs were also reviewed for bone adaptations, acromial fractures, scapular notching, and humeral loosening. ResultsThere were 90 patients included in the study, with an average age of 73 years (± 7.23) and clinical follow-up of 32 months (± 7.25). Indications included osteoarthritis with a rotator cuff tear (51%), osteoarthritis without a cuff tear (40%), fracture sequelae (2%), and locked anterior dislocation (2%). There were significant improvements in all measured motions and patient-reported outcome measures at the most recent follow-up, with good to excellent satisfaction in 91.1% of patients. High mean epiphyseal (0.90 ± 0.06) and metaphyseal (0.83 ± 0.07) filling ratios together with low mean diaphyseal filling ratio (0.48 ± 0.07) represented proximal fixation. There were 6 cases with scapular notching, 5 postoperative acromial fractures, and 2 with temporary postoperative neuropathy. Proximal bone resorption was seen in 18.9% of cases, and there were no cases of humeral loosening, baseplate failure, or need for revision. ConclusionPrimary RSA with a third-generation press-fit humeral component with metaphyseal fixation provides excellent early outcomes with no loosening and low rates of proximal stress-shielding. Results of this study support the use of an inlay humeral component with osteointegration features that facilitate proximal stem fixation. Level of EvidenceTreatment Study

Surgery for pre- and minimally invasive lung adenocarcinoma

ObjectiveAdenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) are the pre- and minimally invasive forms of lung adenocarcinoma. We aimed to investigate safety results and survival outcomes following different types of surgical resection in a large sample of patients with AIS/MIA. MethodsMedical records of patients with lung AIS/MIA who underwent surgery between 2012 and 2017 were retrospectively reviewed. Clinical characteristics, surgical types and complications, recurrence-free survival, and overall survival were investigated. ResultsA total of 1644 patients (422 AIS and 1222 MIA) were included. The overall surgical complication rate was significantly lower in patients receiving wedge resection (1.0%), and was comparable between patients undergoing segmentectomy (3.3%) or lobectomy (5.6%). Grade ≥ 3 complications occurred in 0.1% of patients in the wedge resection group, and in a comparable proportion of patients in the segmentectomy group (1.5%) and the lobectomy group (1.5%). There was no lymph node metastasis. The 5-year recurrence-free survival rate was 100%. The 5-year overall survival rate in the entire cohort was 98.8%, and was comparable among the wedge resection group (98.8%), the segmentectomy group (98.2%), and the lobectomy group (99.4%). ConclusionsSublobar resection, especially wedge resection without lymph node dissection, may be the preferred surgical procedure for patients with AIS/MIA. If there are no risk factors, postoperative follow-up intervals may be extended. These implications should be validated in further studies.

Dysphagia and Satisfaction Following Anterior Cervical Spine Surgery: A Prospective Observation Trial.

Prospective observation. To assess the effect of dysphagia on patient satisfaction following anterior cervical discectomy and fusion. Difficulty with swallowing is a common complaint following anterior cervical spine surgery. The exact impact of this issue on the patient's overall satisfaction is unknown because of its often-transient nature. A prospective evaluation of all patients from a single surgeon undergoing an anterior cervical spine surgery. Dysphagia was evaluated both preoperatively and postoperatively at set intervals via a combination of 3 validated scoring systems. Mean satisfaction scores at 6 months was evaluated at 6 months via modified CSRS survey. Comparative analysis was performed to determine if there was any relationship between the 2 outcomes. A total of 96.77% (68/71) of enrolled patients completed all of their follow-up surveys. The prevalence of dysphagia was 32.4% at 2 weeks after surgery, 20.6% at 6 weeks, 13.2% at 3 months, and 13.2% at 6 months. In total, 82.35% (56/68) of patients were satisfied with their surgical outcome and only 5.88% (4/68) were dissatisfied with their outcome. There was no relationship between a patient's overall satisfaction level and the presence of dysphagia at any postoperative interval. The absence of neck pain at 6 months was the only significant predictor of patient satisfaction (P=0.003). Dysphagia is a common but often transient complaint following anterior cervical spine surgery. Fortunately, its presence does not seem to correlate with a patient's overall satisfaction level following surgery. Level I.

Enhancement of Impaired MRSA-Infected Fracture Healing by Combinatorial Antibiotics and Modulation of Sustained Inflammation.

Fracture healing is impaired in the setting of infection, which begets protracted inflammation. The most problematic causative agent of musculoskeletal infection is methicillin-resistant Staphylococcus aureus (MRSA). We hypothesized that modulation of excessive inflammation combined with cell-penetrating antibiotic treatments facilitates fracture healing in a murine MRSA-infected femoral fracture model. Sterile and MRSA-contaminated open transverse femoral osteotomies were induced in 10-week-old male C57BL/6 mice and fixed via intramedullary nailing. In the initial therapeutic cohort, empty, vancomycin (V), rifampin (R), vancomycin-rifampin (VR), or vancomycin-rifampin-trametinib (VRT) hydrogels were applied to the fracture site intraoperatively. Rifampin was included because of its ability to penetrate eukaryotic cells to target intracellular bacteria. Unbiased screening demonstrated ERK activation was upregulated in the setting of MRSA infection. As such, the FDA-approved mitogen-activated protein kinase kinase (MEK)1-pERK1/2 inhibitor trametinib was evaluated as an adjunctive therapeutic agent to selectively mitigate excessive inflammation after infected fracture. Two additional cohorts were created mimicking immediate and delayed postoperative antibiotic administration. Systemic vancomycin or VR was administered for 2 weeks, followed by 2 weeks of VRT hydrogel or oral trametinib therapy. Hematologic, histological, and cytokine analyses were performed using serum and tissue isolates obtained at distinct postoperative intervals. Radiography and micro-computed tomography (μCT) were employed to assess fracture healing. Pro-inflammatory cytokine levels remained elevated in MRSA-infected mice with antibiotic treatment alone, but increasingly normalized with trametinib therapy. Impaired callus formation and malunion were consistently observed in the MRSA-infected groups and was partially salvaged with systemic antibiotic treatment alone. Mice that received VR alongside adjuvant MEK1-pERK1/2 inhibition displayed the greatest restoration of bone and osseous union. A combinatorial approach involving adjuvant cell-penetrating antibiotic treatments alongside mitigation of excessive inflammation enhanced healing of infected fractures. © 2022 American Society for Bone and Mineral Research (ASBMR).

Naloxone Continuous Infusion for Spinal Cord Protection in Endovascular Aortic Surgery Leads to Higher Opioid Administration and More Pain

Compare total perioperative opioid use in patients receiving naloxone continuousinfusion (NCI) for spinal cord ischemia prophylaxis, versus patients not receiving NCI, in endovascular aortic repair. Single-center, retrospective cohort review. Academic medical center. Patients undergoing elective thoracic, thoracoabdominal, or abdominal aortic endovascular repair. Patients were separated based on the use of naloxone continuous infusion as part of a spinal protection protocol. Primary endpoint was opioid requirements, in milligram morphine equivalents (MME), during the first 48 hours or during NCI. Secondary endpoints included: postoperative pain scores during the same interval; opioid requirements during hours 48 to 72; and pain scores during hours 48 to 72. Ninety-five procedures were included; 43 received naloxone continuous infusion and 52 patients were in the non-naloxone group. Opioid use from a linear mixed model was elevated across the entire continuum in the naloxone group (18 MMEs, 95% CI 13-24), with the greatest difference seen at the 24-to-48-hour interval (51 MMEs, 95% CI 26-75) after adjustment for age, incisions, and prehospital opioid use. In the naloxone group, pain score estimates were elevated at each postoperative interval of evaluation, with similar adjustment. Across the continuum this was 0.7 higher (95% CI 0.2-1.3); the zero-six-hour and six-to-12-hour intervals were 0.9 (95% CI 0.4-1.4) and 1.2 higher (95% CI 0.7-1.7). Patients receiving anloxone continuous infusion to prevent spinal cord ischemia required greater quantities of opioids and had higher postoperative pain, compared with patients not requiring naloxone.