Postoperative Time Period Research Articles

Radiographic Assessment of Shoulder Position in 619 Idiopathic Scoliosis Patients: Can T1 Tilt Be Used as an Intraoperative Proxy to Determine Postoperative Shoulder Balance?

The purpose of this study is to assess radiographic shoulder measures from the preoperative to the postoperative time period, specifically to determine whether T1 tilt could be used as an intraoperative proxy for shoulder balance determination. This study focused on radiographic shoulder measures of 619 adolescent idiopathic scoliosis patients who underwent spinal deformity surgery. A prospective, multicenter database of adolescent idiopathic scoliosis was queried to identify all patients who had undergone spinal deformity surgery with >2 years of follow-up postoperatively. Radiographic analysis focused on measures of shoulder balance: T1 tilt, clavicle angle, and radiographic shoulder height. A total of 619 patients were included in this analysis. Mean age at surgery was 14.8 years with 83% female. Mean preoperative curve size was 58.0 degrees. Mean T1 tilt preoperatively was -0.10 degrees and postoperatively 2.42 degrees. Mean clavicle angle preoperatively was -1.39 degrees and postoperatively 0.79 degrees. Mean radiographic shoulder height preoperatively was -7.04 mm and postoperatively 1.63 mm. All 3 radiographic parameters demonstrated reasonable correlation preoperatively and postoperatively to each other. To assess the viability of T1 tilt as an intraoperative proxy for shoulder balance, standardized ratios between the variables were created. Analysis of these ratios demonstrated little or no relationship preoperatively to postoperatively, hence the relationship of T1 tilt to radiographic shoulder height does not remain constant. Analysis of the relationship of T1 tilt to radiographic shoulder height from preoperative to postoperative did not demonstrate consistency. Lenke 3 and 6 curve patterns demonstrated preoperative to postoperative correlation, both with nonstructural proximal thoracic curves; however, for the remaining curve patterns T1 tilt cannot be used as an intraoperative proxy for shoulder balance. Level IV.

Abstract PR331

Background & Objectives: Total Knee Arthroplasty (TKA) is a common surgical procedure for patients with end stage joint disease [1]. Poorly controlled pain in the post-operative setting is associated with higher levels of opioid use and opioid related adverse effects, immobility, morbidity, longer hospital admissions, and decreased overall patient satisfaction [2]. There is no current gold standard for pain reduction in the post-operative time period. One narcotic alternative, intravenous acetaminophen, was first commercialized in Europe in 2002 and has subsequently been approved by the FDA. Preliminary studies have found it safe and efficacious for decreasing post-operative pain, including TKA. We plan to perform a three arm study comparing the clinical advantages of a periarticular liposomal bupivacaine injection versus a standardized knee injection cocktail previously described versus this same knee injection cocktail with the addition of intravenous acetaminophen on decreasing opioid related side effects without sacrificing expected levels of analgesia. The main study endpoints will be a Visual Analogue Score (VAS) Pain score and Opioid Related Symptoms Distress Scale (OR-SDS). Additional endpoints will include Total Morphine Equivalents (TME) administered, Actual Length of Stay, Active Knee Range of Motion, and Discharge location. Materials & Methods: This will be a randomized, prospective, single-center clinical trial to evaluate the efficacy of three treatment methods on reducing pain in patients undergoing a TKA. The study will involve 141 patients divided evenly into three treatment arms. All patients in this study will be treated with the standardized spinal anesthesia, the standardized adductor canal block, 10 mg of dexamethasone intravenously, and four postoperative doses of IV ketorolac (15 mg every eight hours for forty-eight hours). The Standardized Spinal Anesthesia After it is washed with epinephrine, between 1.4 ml to 2 ml of hyperbaric bupivacaine will be drawn into the syringe (with dosage dependent on the height of patient and duration of surgery). The Standardized Adductor Canal Block Periarticular Liposomal Bupivacaine Injection Treatment Group Standardized Knee Cocktail Treatment Group IV Acetaminophen Plus Standardized Knee Cocktail Treatment Group Results: The results of the 141 currently enrolled patients will be reported after statistical analysis. Conclusion: The result of the 141 currently enrolled patients will be reported after statistical analysis with conclusions to follow.

Prognosis of meningiomas in the early 1970s and today

ObjectiveThe benefit of the current strategy of diagnosis and treatment of meningiomas in contrast to the standard treatment in use before computer tomographic and magnetic resonance imaging and before the microsurgical era has not yet been determined. MethodsTwo groups of patients were compared, those on which surgery was performed before the year of 1985, when computer tomographic (CT) imaging was not yet available in our clinic and those who were treated after at the Neurosurgical Department of Saarland University. Average follow-up time was 17.9±9.3years for group 1 and 9.2±4.3years for group 2. ResultsThe number of patients with advanced age who had surgical treatment was significantly increased in the second group, whereas the number of perioperative complications found was nearly equal in both groups (17.8% vs. 18.8%). Nevertheless, perioperative morbidity was reduced from 2.2% to 1.2%. The postoperative recurrence free time period could be revealed to be longer in the first collective (p<0.0001). Furthermore, this study shows a notable increase of the incidence of WHO grade II meningiomas in patients treated after 1985. ConclusionsBased on the presented results, the overall prognosis for patients with meningiomas has changed from the 1960s until today, since over the last two decades there has been a prolonged progression free survival time in addition to a reduced perioperative mortality rate.In the postoperative management of these patients genetic aberrations and microbiological markers should be considered as prognostic factors for meningiomas in addition to histopathological grading.

An analysis of spine fusion outcomes in sheep pre-clinical models.

The ovine model is often used to evaluate new spine fusion technologies prior to clinical testing. An important aspect of designing sheep surgery protocols is to select the appropriate postoperative time period for comparing fusion outcomes. Unfortunately, determining the ideal study endpoint is complicated by the fact that prior published studies have not used consistent timeframes. Thus, the primary aim of this study was to provide a reference for investigators as to the expected fusion outcomes of control groups at varying timepoints in sheep spine surgery models. We identified published sheep fusion studies using autograft, interbody cages, and/or instrumentation. Fusion data were extracted, converted to a common scale, and analyzed across studied timepoints. Overall, 29 studies of 360 fusion levels were identified: 11 ALIF (158 levels), 3 PLIF/TLIF (28 levels), 8 PLF (90 levels), and 7 ACDF (84 levels). Studied timepoints ranged from 4 to 48weeks postoperative. In general, fusion rates varied across techniques and instrumentation. The time to reach solid fusion differed by as many as 20weeks between control groups. Recommended timeframes for future studies designed to show either superiority over controls or equivalent outcomes with controls were developed based on aggregate results. Designating ideal study endpoints for sheep fusion models has both ethical implications associated with responsible use of animals in research, and economic implications given the cost of animal research. The current results can guide the development of future research methods and help investigators choose appropriate study timelines for various control groups.

The Influence of the Fusion Degree of the Vertebrae on the Process of Destabilization of the Pedicle Fixation System after TLIF and PLIF

Introduction The stability of the PSF system in the postoperative period of time is an important component of well-being of the patients. In case of destabilization of PSF systems revision surgery is often required and brings high costs and has increased number of complications. The main reasons for the destabilization of the rigid stabilization systems are: osteoporosis, non fusion, pseudarthrosis, a violation of the prescribed protective regime Material and Methods 409 patients after decompressive-stabilizing operations on the lumbar spine type TLIF or PLIF. All patients were operated because of spinal stenosis in the period since 25.12.2012 till12.27.2013 by five surgeons working in the same department. There were 235 male (57.5%) and 174 female (42.5%) aged 18–75 (50,3 ± 1,2). There were one-level process - 296 (72.4%), two-level process - 98 (23.9%), a three-level process - 11 (2.6%), more than 3 levels - 4 (1.1%). Totaly 539 segments were operated. We used following cages as interbody implants: Leopard – 65 (12%), Concorde – 92 (17%), Capstone – 156 (29%), Surgical Titanium Mesh – 226 (42%). Cages were filled with autologous bone graft. Crushed bone stacked densely around the cage. After installation cage we performed compression on the elements of PSF system. Follow-up period was of 2 years. Formation of the bone block was evaluated by Bridwell classification Results Complete regression of the initial neurological symptoms as a result of the decompression achieved in 325 (79,5%) patients, partial – 58 (14%), no change – 20 (5%), the deterioration – 6 (1.5%). Post-operative examination and X-ray and CT control were delivered within 3–6-12 and 24 months. 335 (82%) patients were control examined after 1 year, 258 (63%) after 2 years. After 1 year the 1st Bridwell fusion grade was marked at 325 (79.6%) patients, grade 2 – 60 (14.7%), grade 3 – 13 (3.2%), grade 4 – 10 (2.5%). The material of the implant had no effect on the fusion. Among patients (23 patients total) with 3 and 4 Bridwell grade of fusion we used as interbody implant: Peek 7 (30,6%), Carbon 8 (34,7%), Surgical titanium mesh 8 (34,7%). It is obvious that the reason of non fusion is not the material of the implant, and other factors (quality of treatment interbody gap, cage height and the degree of contact with the endplate vertebral body, especially vertebral vascularization, surgical technique, and others). Instability and fractures of nodes of PSF system for two years after surgery were found in 13 (3,17%) patients. This revealed that the destabilization or fracture structure were determined just in cases of pseudarthrosis (3 and 4 Bridwell grade) Conclusion The main goal of TLIF and PLIF is fusion in operated segment. Non fusion with pseudarthrosis cause instability and fracture of PSF in most cases. The interbody implant material does not matter. Quality of treatment interbody gap and degree of contact with the vertebral endplates, сage and bonegraft are most important.

Diet-induced thermogenesis in postoperatve Roux-en-Y gastric bypass patients with weight regain

BackgroundBariatric surgery has been shown to be an effective treatment for obesity. Changes in energy expenditure, especially through diet-induced thermogenesis (DIT), have been identified as one of the mechanisms to explain this success. However, not all patients are able to maintain healthy postoperative weight loss. Therefore, a question arises: In the weight regain after bariatric surgery, are these changes in energy metabolism still active? ObjectiveTo investigate if weight regain after Roux-en-Y gastric bypass (RYGB) surgery is associated with a lower diet-induced thermogenesis in the late postoperative period. SettingA cross-sectional study with the participants chosen from among the patients from a private practice. MethodsThis was a cross-sectional study where 3 groups of female patients were evaluated: (1) 20 patients with a RYGB postoperative time period of at least 2 years, who kept a healthy weight after surgery (loss of at least 50% of excess weight; Healthy group); (2) 19 patients with clinically severe obesity (BMI>40 kg/m2, without co-morbidities and>35 kg/m2, with co-morbidities; Pre group); (3) 18 patients who experienced weight regain after RYGB (Regain group). The 3 groups were submitted to indirect calorimetry to measure resting metabolic rate (RMR), respiratory quotient (RQ), and DIT. Immediately after the RMR measurement, a mixed meal of regular consistency was offered. Ten minutes after the food intake began, energy expenditure measurements were initiated continuing throughout the following 3 postprandial hours. Body composition was evaluated using multifrequency bioelectrical impedance. In subgroups of the studied population, glucose and insulin levels were measured at baseline and at 30, 60, 90, 120, and 180 minutes after feeding. The mean area under the curve (AUC) between the 3 groups and measurements at baseline were compared using the analysis of variance (ANOVA). ResultsThe Healthy group had the highest weight adjusted RMR value compared with both the Pre and Regain group (23.03±3.02 kcal/kg; 16.18±2.94 kcal/kg; 17.11±3.28 kcal/kg, respectively; P<.0001). The Regain and Pre groups showed no difference for this variable. The weight-adjusted DIT (AUC 0–180 min) was about 42% and 34% higher in the Healthy group compared with the Pre and Regain groups, respectively (P<.0001). Lean body mass (kg) showed a positive correlation with the AUC of weight-adjusted DIT in the 3 groups. Multiple regression revealed that lean body mass was the only variable related to weight adjusted DIT, independent of group and other selected variables. ConclusionWeight-adjusted DIT in the Regain group was smaller compared with the Healthy group, and with no difference compared with the Pre group. The lean body mass seems to have a positive association with diet-induced thermogenesis.

Anterior Cruciate Ligament Functional Sports Asssessment

The incidence of anterior cruciate ligament (ACL) patients has doubled in the past 5 years at Rush University Orthopaedics. Additionally, there has been a 3-fold increase in the number of anterior cruciate ligament injuries in patients younger than the age of 25 years of age during this 5-year period. Fortunately, approximately 80%-90% of these patients return to their sports at their previous level of play. However, with the increased incidence in tears, it is important for medical providers to assist the patients in determining the risk factors they may display when preparing to return to sport. There are very few published return to sport guidelines following anterior cruciate ligament reconstruction. Midwest Orthopaedics at Rush has developed a functional sports assessment (FSA) to evaluate anterior cruciate ligament injury risk factors on postoperative patients. The FSA factors include range-of-motion, strength, endurance, proprioception, power, core stability, ankle stability, and overall biomechanics and confidence. Although the FSA has not been proven reliable or valid, it is based on the other commonly used tasks in determining a patient’s ability after anterior cruciate ligament surgery. It has been clinically relevant for the patient, therapist, athletic trainer, and physician in identifying weaknesses and risk factors at the 5-6 month time postoperative time period. This helps to guide the patient in what tasks he or she needs to be attentive to during the transition to return to sport to minimize reinjury. This article provides factors that were considered when developing the FSA, a detailed description of the FSA, and future considerations to improve the assessment for validity and reliability.

Necessity for fibular fixation associated with distal tibia fractures.

Intramedullary (IM) nailing is a well-accepted treatment for distal third tibia fractures in combination with injury to the fibula. However, the indications for operative stabilisation of the fibula remain controversial. The authors performed a retrospective review on a consecutive series of patients who underwent intramedullary nailing of a non-comminuted distal third tibia fracture with or without fibular fixation at a Level I urban trauma centre. A review of surgical records identified 120 patients who initially were included in this study, while a total of 98 patients who met the inclusion criteria were included in the final analysis. Our results found no difference in the mean value of coronal and sagittal plane alignment in both the immediate post-operative and follow-up time periods. We also saw no statistically significant difference when comparing malalignment between patients treated with or without fibula fixation. There were no deep infections between the two groups. No significant differences were seen between the fibular fixation group and the non-fixation group. Distal screw removal due to prominence or pain was the most common reason for future surgery in both groups. These findings suggest that the addition of fibular fixation does not affect whether or not alignment is maintained in either the immediate post-operative or short-term follow-up period.

Timing of Complications After Spinal Fusion Surgery

Retrospective cohort study. To characterize the timing of complications after spinal fusion procedures. Despite many publications on risk factors for complications after spine surgery, there are few publications on the timing at which such complications occur. Patients undergoing anterior cervical decompression and fusion (ACDF) or posterior lumbar fusion (PLF; with or without interbody) procedures during 2011-2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. For each of 8 different complications, the median time from surgery until complication was determined, along with the interquartile range and middle 80%. A total of 12,067 patients undergoing ACDF and 11,807 patients undergoing PLF were identified. For ACDF, the median day of diagnosis (and interquartile range; middle 80%) for anemia requiring transfusion was 0 (0-1; 0-2), myocardial infarction 2 (1-5; 0-15), pneumonia 4 (2-9; 1-14), pulmonary embolism 5 (2-9; 1-10), deep vein thrombosis 10.5 (7-16.5; 5-21), sepsis 10.5 (4-18; 1-23), surgical site infection 13 (8-19; 5-25), and urinary tract infection 17 (8-22; 4-26). For PLF, the median day of diagnosis (and interquartile range; middle 80%) for anemia requiring transfusion was 0 (0-1; 0-2), myocardial infarction 2 (1-4; 1-8), pneumonia 4 (2-9; 1-17), pulmonary embolism 5 (3-11; 2-17), urinary tract infection 7 (4-14; 2-23), deep vein thrombosis 8 (5-16; 3-20), sepsis 9 (4-16; 2-22), and surgical site infection 17 (13-22; 9-27). These precisely described postoperative time periods enable heightened clinical awareness among spine surgeons. Spine surgeons should have the lowest threshold for testing for each complication during the time period of greatest risk. Authors, reviewers, and surgeons utilizing research on postoperative complications should carefully consider the impact that the duration of follow-up has on study results. 3.

Impact of Postoperative Antibiotic Prophylaxis Duration on Surgical Site Infections in Autologous Breast Reconstruction.

Although some surgeons prescribe prolonged postoperative antibiotics after autologous breast reconstruction, evidence is lacking to support this practice. We used the Tracking Operations and Outcomes for Plastic Surgeons database to evaluate the association between postoperative antibiotic duration and the rate of surgical site infection (SSI) in autologous breast reconstruction. The intervention of interest for this study was postoperative duration of antibiotic prophylaxis: either discontinued 24 hours after surgery or continued beyond 24 hours. The primary outcome variable of interest for this study was the presence of SSI within 30 days of autologous breast reconstruction. Cohort characteristics and 30-day outcomes were compared using χ² and Fischer exact tests for categorical variables and Student t tests for continuous variables. Multivariate logistic regression was used to control for confounders. A total of 1036 patients met inclusion criteria for our study. Six hundred fifty-nine patients (63.6%) received antibiotics for 24 hours postoperatively, and 377 patients (36.4%) received antibiotics for greater than 24 hours. The rate of SSI did not differ significantly between patients given antibiotics for only 24 hours and those continued on antibiotics beyond the 24-hour postoperative time period (5.01% vs 2.92%, P = 0.109). Furthermore, antibiotic duration was not predictive of SSI in multivariate regression modeling. We did not find a statistically significant difference in the rate of SSI in patients who received 24 hours of postoperative antibiotics compared to those that received antibiotics for greater than 24 hours. These findings held for both purely autologous reconstruction as well as latissimus dorsi reconstruction in conjunction with an implant. Thus, our study does not support continuation of postoperative antibiotics beyond 24 hours after autologous breast reconstruction.

Imaging of Left Ventricular Assist Devices

Left ventricular assist devices (LVADs) are electromechanical pumps that aid the failing heart and are essential option in the modern management of heart failure that may serve as a bridge to transplantation and provide destination therapy or short-term recovery for cardiogenic shock. As a complement to echocardiography, computed tomography (and to a lesser extent radiography or nuclear scintigraphy) plays an essential role in the evaluation of LVAD complications in both the perioperative and late post-operative time periods. These complications and their imaging appearances are reviewed in this article.

Do Elderly Patients Use Patient-Controlled Analgesia Medication Delivery Systems Correctly?

Although prior studies have shown patient-controlled analgesia (PCA) to be appropriate for use by children and adults, no studies have specifically evaluated the ability of elderly patients to use the technology correctly. To determine whether elderly, postoperative patients can properly use PCA devices. Using a descriptive study design, a convenience sample of elderly, postoperative orthopedic patients was observed while using a PCA device and surveyed about the proper use of the device. Participants were observed and surveyed 12 to 20 hours after admission to the postoperative patient care unit. Frequency and amount of analgesic medication administration over the postoperative time period were also recorded. Data were summarized with descriptive statistics and multiple regression analysis was used to determine whether confounding variables explained problems using the PCA device correctly. A total of 58 orthopedic patients were studied during the first day after surgery. Patients had used the PCA device for 16.6 ± 3.0 (mean ±SD) hours at the time of the observation and survey. Virtually all patients correctly identified and depressed the PCA activation button when instructed, knew when to use the PCA device, and who was allowed to depress the PCA button. Slightly more than half of the patients (57%) correctly identified how often they could have PCA medication, with 38% not sure of PCA medication frequency. The PCA medication was requested an average of 23.3 ± 52.7 times during the study period. The majority of the patients (86%) requested PCA medication less than 25% of the times that they could receive PCA medication. All patients in the study had PCA devices programmed to deliver up to 5 doses per hour of PCA medication, yet an average of 11.2 ± 10.8 doses of PCA medication were actually delivered during the entire study period (average 16.6 hours). Average doses of fentanyl and morphine sulfate received by patients were 13.5 μg/hour and 1.0 mg/hour, respectively. Elderly patients were very knowledgeable about how to use the PCA device but not about how often they could receive PCA medication. This lack of knowledge may have influenced how often they requested pain medication, because almost 90% of patients received less than 25% of the PCA allowable medication dose. This low usage of PCA medication delivery calls into question the cost-effectiveness of this method of medication delivery for the elderly. Additional studies are needed to verify these findings in other elderly patients.

New onset of diabetes after transplantation is associated with improved patient survival after liver transplantation due to confounding factor

BackgroundThe influence of NODAT on survival of liver transplant recipients has not been clarified. Therefore, we evaluated the effect of NODAT on survival in LT recipients. MethodsData from 352 LT patients were totally analyzed. 97 patients with pretransplant diabetes mellitus were excluded, and 255 patients without diabetes mellitus at time of transplantation were included. ResultsNODAT was diagnosed in 41 patients (16.1%). There was no difference in frequency of NODAT according to the etiology of liver cirrhosis. NODAT was associated with a higher body weight (p=0.004) and BMI (p=0.002) 5years after LT, but not with weight gain (p=0.201) or increase in BMI (p=0.335) 5years after LT. HbA1c 5years after LT was significantly higher in patients with NODAT (p=0.001), but mean HbA1c still remained lower than 6.5% (6.4(±1.2) %). Patients with NODAT showed better survival rates (log rank: p=0.002) compared to LT recipients without diabetes. According to all existing knowledge of diabetes mellitus (DM) better survival cannot be a direct effect of this disease. Our results are rather influenced by an not known confounding factor (possibly recovery from cachexia) associated with better survival and NODAT, while complications of NODAT will not appear during the relatively short postoperative time and observation period (mean follow up 6.08 (±2.67) years). ConclusionNODAT is frequently diagnosed in LT recipients and is associated with an improved 5year survival after LT due to a not exactly known confounding factor.

Radiographic Variables That May Predict Clinical Outcomes in Cervical Disk Replacement Surgery

Retrospective analysis of prospectively collected data. To determine which, if any, radiographic parameters are predictive of clinical outcome after cervical disk replacement (CDR) surgery. It is unclear whether radiographic parameters are predictive of outcome after CDR. An analysis of the radiographic parameters and clinical outcomes of the CDR cohort of the Discover artificial cervical disk IDE trial was performed. Clinical outcome measures included Neck Disability Index (NDI), visual analog pain scale (neck, arm, and shoulder), and SF-36 physical component summary score scores, collected preoperatively and at regularly scheduled postoperative time periods. Patients with at least 1-year follow-up were included. The change in outcomes from baseline was determined at each follow-up interval. The following minimal clinically important difference (MCID) thresholds were applied: -7.5 for NDI, -25 for visual analog pain scale, and +4.1 for physical component summary score. Fifty-six radiographic variables were analyzed to identify factors that may be associated with a poor clinical outcome, defined as failure to achieve the MCID in NDI. A total of 243 patients underwent CDR at 304 levels (182 one level, 61 two level). One hundred seventy-one patients (89 female, 82 male; mean age, 44.2 y; range, 28-67 y) had at least 1-year follow-up. A preoperative disk height of <3.5 mm was associated with a 3.4 times greater risk of not achieving a MCID in NDI (P=0.018). Increasing the functional spinal unit angle by >3 degrees was associated with a 3.5 times greater risk of not achieving a MCID in NDI (P=0.016). There were 21/171 patients (25 levels) who did not achieve the NDI MCID threshold. All of these patients had at least1, and 16/21 of these patients had more than 1 abnormal radiographic finding. Seventy percent of treatment levels had severe or bridging heterotopic ossification at 3-years follow-up, the incidence of which increased linearly with time. Several radiographic variables are predictive of clinical outcomes, including decreased preoperative disk space height and excessive postoperative segmental lordosis.

Giant Petrous Bone Osteoma Associated With Ipsilateral Clivus Meningioma in an Adult

Background and Importance: An association with multiple primary intracranial tumors of different histologic types not relating to radiotherapy or phacomatosis is a rare event. To the best of the authors’ knowledge, a giant osteoma originating from the inner surface of the petrous bone associated with an ipsilateral clivus meningioma has never been reported. Clinical Presentation: A 43-year-old patient with trigeminal neuralgia was found to have a posterior fossa bony lesion measuring 4 cm, with a solid enhancing lesion in juxtaposition and a separate bony lesion on the occipital bone on magnetic resonance and computed tomography imaging. A satisfactory resection of the coexisting tumors in the petroclival region was performed through a subtemporal transtentorial approach. The tumors were finally confirmed as an osteoma and a meningioma by pathologic evaluation. The patient demonstrated an improvement in her trigeminal neuralgia over a 3-month postoperative period of time. Conclusions: This case presents new clinical and radiographic findings associated with a rare lesion. Dependent tumors that one tumor may act as an irritating agent for the local proliferation of the other most likely accounted for this pattern of tumoral linkage. A satisfactory surgical result was achieved through a relatively minimal approach and different strategies. Trigeminal neuralgia, the initial presenting symptom, improved during the follow-up period.

Management of complications after rotator cuff surgery.

Rotator cuff repair (RCR) is a common procedure performed by orthopedic surgeons via arthroscopic, open, or mini-open techniques. While this surgery is considered to be of low morbidity, several potential complications can arise either intraoperatively or during the postoperative time period. Some of these complications are related to the surgical approach (arthroscopic or open), while others are patient dependent. Many of these complications can be managed through nonoperative means; however, early recognition and timely treatment is essential in limiting the long-term sequela and improving patient outcome. There are several different ways to classify complications after RCR repair: timing, severity, preventability, whether or not the pathology is intra- or extra-articular, and the type of treatment necessary. It is essential that the surgeon is cognizant of the etiology contributing to the failed RCR surgery in order to provide timely and proper management.

Corrective Realignment Arthrodesis of the First Tarsometatarsal Joint Without Wedge Resection.

Moderate to severe hallux valgus (HV) has traditionally been treated with a corrective osteotomy or a tarsometatarsal arthrodesis. Tarsometatarsal arthrodesis can be performed as a planar wedge resection or using a joint curettage technique. Little is known about whether adequate correction can be obtained with purely a joint curettage technique. The purpose of this study is to evaluate the corrective power of a first tarsometatarsal joint (TMTJ) arthrodesis using a nonplanar wedge curettage technique. A retrospective radiograph and chart review was performed on 99 consecutive patients (110 feet) who underwent a first TMTJ arthrodesis for primary HV correction utilizing a curettage technique. The radiographic measurements collected were the first intermetatarsal angle, HV angle, and tibial sesamoid position and were obtained at the following intervals: preoperative, immediate postoperative, and 6 months postoperative. In all, 91 patients (100 feet) qualified for statistical analysis. There was a significant decrease in all 3 measurements from the preoperative throughout the entire postoperative time period (P < .001). The authors demonstrate the ability to achieve significant angular correction with a joint curettage method for a tarsometatarsal arthrodesis. Therapeutic, Level IV: Case series.

Systematic review of surgical treatments for cranial cruciate ligament disease in dogs.

Surgery for cranial cruciate ligament disease is often recommended; however, it is unclear if one procedure is superior. The aim of this systematic review was to answer the a priori question, "Is there a surgical procedure that will allow a consistent return to normal clinical function in dogs with cranial cruciate ligament disease and is that procedure superior to others?" A systematic literature search was performed through September 2013. Peer reviewed publication in the English language and 6 mo of postoperative follow-up were required. In total, 444 manuscripts were identified and reviewed, and 34 met the inclusion criteria. Two studies provided level 1, 6 provided level 2, 6 provided level 3, and 20 provided level 4 evidence relative to the study question. The most common surgical procedures included tibial plateau leveling osteotomy (TPLO, n = 14), lateral extracapsular suture (n = 13), tibial tuberosity advancement (n = 6). The strength of the evaluated evidence most strongly supports the ability of the TPLO in the ability to return dogs to normal function. It also provided strong support that functional recovery in the intermediate postoperative time period was superior following TPLO compared with lateral extracapsular suture. There was insufficient data to adequately evaluate other surgical procedures.

ANTIBIOTIC RESISTANCE OF THE BACTERIA ISOLATES OBTAINED FROM THE PATIENTS WITH DIABETES AND HIV-INFECTED PATIENTS IN CARDIOSURGICAL HOSPITAL

Abstract. The study was performed in the Perm Krai Clinical Hospital N 2 “Heart Institute”. The aim of this study was to evaluate the antibiotic susceptibility in isolates from patients with diabetes mellitus and HIV-infected patients. In all groups involved in the study (patients with diabetes mellitus, patients with HIV infection, and control group) the predomination of the Gram-positive species have been revealed. This fact is typical for surgical departments. More isolates of Staphylococcus aureus were found in the group of HIV-infected patients compared to patients in the control group (20.6% vs 4.6%, p = 0.02, respectively). Oxacillin resistance rate in Staphylococcus aureus was higher in the group of HIV-infected patients than in patients from the control group. Significant differences in Staphylococcus epidermidis resistance rate between HIV-infected patients and patients in the control group were detected for oxacillin (60% vs 10%, p = 0.03, respectively). It is plausible that in the group of immunocompromised patients vancomycin might be recommended for empiric therapy of infections caused by gram-positive species. The Enterococcus faecalis was more often isolated from HIV-infected patients in compare with patients from the control group (34.5% vs 13.8%, p = 0.02), probably due to severe immunodeficiency in the late stages of HIV infection. The absence of significant differences in resistance rate in Staphylococcus aureus and Staphilococcus epidermidis between patients with diabetes and patients in the control group could be considered as important. This fact might be associated with judicious control of glycemia during the pre-, intra-, and postoperative time periods. Postoperative pyoinflammatory diseases remain serious obstacle for the progress in cardiosurgery. Consequently, it’s important to know the characteristics of the microflora, colonizing the patients.

The impact of obesity on adult tracheostomy complication rate.

Prospectively compare tracheostomy-related complications in obese patients with complications in nonobese patients. Prospective cohort study. Adult patients undergoing tracheostomy were studied. Patients who had a prior tracheostomy were excluded. Complications were classified as intraoperative, early (within the first 2 weeks), or late. A total of 151 patients met inclusion/exclusion criteria. Fifty-five percent of obese patients experienced at least one tracheostomy-related complication; 19.5% of the control group had a complication. Mean procedure duration for patients with body mass index < 30 was 24.74 minutes and for obese patients was 46.17 minutes. There was a statistically significant effect of body mass index on complication rate (P < .0001) and on procedure duration (P < .0001). The relationships between body mass index and intraoperative complications (P = .027) and early postoperative complications (P = .001) were significant. The tracheostomy-related complication rate is significantly higher for obese patients, especially for body mass index ≥ 35, especially in the intraoperative and early postoperative time periods. Procedure duration is significantly longer in obese patients.