Preoperative Findings Research Articles

Emergency primary anastomosis with or without intraoperative colonic lavage following sigmoidectomy in sigmoid volvulus: 175-patient experience in a tertiary referral hospital

Objectives: Emergency primary anastomosis following sigmoidectomy is one of the main treatment options in sigmoid volvulus (SV). However, during this procedure, the role of intraoperative colonic lavage (ICL) is controversial. Our aim was to evaluate the role of ICL in 175-patient SV series. Methods: In Ataturk University Faculty of Medicine Department of General Surgery, ICL was applied in 76 cases (43.4%), while it was not used in the remained 99 patients (56.6%) in 58.5-year period. In a partial retrospective (first 20 years, from June 1966 to June 1986) and prospective (later 38.5 years, from June 1986 to December 2024) evaluation, some preoperative, operative, and postoperative findings were utilized. Results: As preoperative data, mean age (56.4 years vs. 57.1 years, P>0.05), male/female ratio (4.8 vs. 4.2, P>0.05), and rate of shock (5.3% vs. 6.1%, P>0.05) were statistically similar in both groups, while mean ASA score (3.1 vs. 2.9, P<0.05) was significantly lower in ICL group. Among operative findings, rates of bowel gangrene (67.1% vs. 63.6%, P>0.05) and perforation (1.3% vs. 1.0%, P>0.05) were statistically similar in both groups, while mean operation time (205.4 minutes vs. 176.8 minutes, P<0.005) was significantly longer in ICL group. As surgical outcomes, rates of mortality (13.2% vs 12.1%, P>0.05) and morbidity (39.5% vs. 28.3%, P>0.05) were statistically similar in both groups, while mean hospitalization time (14.7 days vs. 9.4 days, P<0.001) was significantly longer and mean cost (3,455.4 USD vs. 2,752.1 USD, P<0.001) was significantly higher in ICL group. Conclusion: When compared with that of primary anastomosis with ICL, primary anastomosis without ICL provided shorter operation and hospitalization times, and less cost in addition to similar mortality and morbidity rates in the emergency treatment of SV. doi: https://doi.org/10.12669/pjms.41.2.11399 How to cite this: Altundas N, Peksoz R, Disci E, Atamanalp SS. Emergency primary anastomosis with or without intraoperative colonic lavage following sigmoidectomy in sigmoid volvulus: 175-patient experience in a tertiary referral hospital. Pak J Med Sci. 2025;41(2):603-607. doi: https://doi.org/10.12669/pjms.41.2.11399 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Fronto-orbital advancement: Comparison of syndromic and nonsyndromic craniosynostosis patients.

Craniosynostosis causes functional and aesthetic problems that require fronto-orbital advancement in patients to correct the cranial deformity and to prevent functional problems due to increased intracranial pressure (ICP). In this study, demographic information, operative details, preoperative clinical findings, and postoperative outcomes were reviewed for 106 craniosynostosis patients with at least 1 year of follow-up. Many factors such as functional losses due to increased ICP before surgery, resynostosis, fronto-orbital relapse, surgical complications and aesthetic results were compared in syndromic and non-syndromic patients. Among 106 patients, 77 (73%) were nonsyndromic, while 29 (27%) were syndromic. The rate of functional losses was higher in syndromic patients before the surgery. We divided the complications into two groups: treatable and untreatable. In both groups, complication rates were higher in syndromic patients than in non-syndromic patients. There were no differences between syndromic and non-syndromic patients in terms of resynostosis and fronto-orbital relaps. Acceptable aesthetic appearance was determined in 83% of syndromic patients and 90% of nonsyndromic patients. Surgical complication rate is higher in syndromic cases than nonsyndromic, but the success rate of surgery is high, and the aesthetic outcomes are acceptable both syndromic and nonsyndromic patients in this study.

Selective Minimally Invasive Strategy for Acute Superior Mesenteric Artery Obstruction.

Acute mesenteric artery obstruction is a severe cause of acute mesenteric ischemia, associated with significant morbidity and mortality. However, there is limited guidance on choosing between traditional and minimally invasive techniques comprehensively. This study introduces a selective, minimally invasive strategy designed to improve the survival and prognosis of patients with acute superior mesenteric artery obstruction. In this prospective, single-arm trial conducted between 2020 and 2023, patients with acute mesenteric ischemia due to acute superior mesenteric artery obstruction were enrolled. A total of 42 patients were included, meeting the predetermined sample size. The primary outcome was the 30-day chronic intestinal failure (CIF)-free survival rate. Based on an algorithm incorporating preoperative radiographic findings, physical signs, and laboratory markers, patients were assigned to one of three therapeutic pathways: traditional laparotomy with thrombectomy, laparoscopy combined with endovascular therapy, or endovascular therapy alone. The CIF-free survival rates at 30 days and 2 years were 71% (30/42) and 60%, respectively. Short-term mortality, including 30-day and in-hospital mortality, was 11.9%, indicating an improvement compared to historical cohorts. The cumulative mortality rates at 6 months, 1 year, and 2 years were 26%, 32%, and 32%, respectively. The primary and assisted patency rates at 1 year were 90% and 97%, respectively. Transition to laparotomy was required in 43% of patients undergoing laparoscopic exploration. Improved blood supply was observed in 73% of the patients who underwent two laparoscopic procedures (15 patients), and bowel resection was avoided in 40% of cases. The median durations of hospitalization and intensive care unit stay were 19 days (IQR 11-31) and 2 days (IQR 0-6), respectively. This selective, minimally invasive strategy for managing acute mesenteric ischemia demonstrated high 30-day CIF-free survival rates and reduced short-term mortality. These findings suggest the potential advantages of this approach in improving outcomes for patients with acute mesenteric ischemia.

Use of computed tomography angiography has potential in planning surgical treatment of an extrahepatic portosystemic shunt in dogs.

To evaluate the impact of intrahepatic portal vein branching (IHPB)-grade assessment using preoperative CT angiography (CTA) on the surgical procedure and prognosis prediction for dogs with an extrahepatic portosystemic shunt (EHPSS). This study involved 146 client-owned dogs with EHPSS. The shunt morphology of EHPSS and IHPB grades was determined using CTA. All dogs underwent surgical attenuation of the shunt with intraoperative portal vein pressure (PVP) measurement, followed by a liver biopsy of the left lateral lobe. The preoperative CTA findings were analyzed according to surgical procedures, intraoperative PVP, hepatic histopathology, and postoperative complications. The grade of IHPB did not correlate with baseline PVP while it significantly correlated with PVP during temporary occlusion and the difference in PVP between before and during the temporary occlusion. The grade of IHPB and PVP had significant differences between the dogs with partial ligation compared with those with complete ligation. The portal vein hypoplasia score on histopathology was generally higher in the dogs with low-grade IHPB than in those with high-grade IHPB. The IHPB grade had no significant influence on postoperative complications and prognosis. This study demonstrated that although the grade assessment system of IHPB using preoperative CTA was unable to predict the prognosis of dogs with a single EHPSS, it may be useful for determining surgical procedure selection. Preoperative CTA is suggested to not only be useful for the diagnosis and classification of EHPSS but also for surgical planning of EHPSS in dogs.

Identifying Patients at Risk for a Facility Discharge Following Elective Total Joint Arthroplasty Using Preoperative Clinical Findings and Patient-Reported Outcome Scores.

Facility discharges following an elective, primary, total joint arthroplasty are infrequent, but are associated with poor outcomes and significant cost. Therefore, investigating ways to identify patients most likely to be discharged to a facility could improve patient care, reduce costs, and potentially lead to strategies to mitigate these risks. A total of 3,198 patients who underwent a total hip or knee arthroplasty between June 2021 and June 2023 were included in this study. Independent factors associated with a discharge to a facility were identified using logistic regressions, and receiver operator curve cut-point analysis was used to determine threshold values for these factors. Facility discharge occurred 138 times (4.3%). A total of 12 factors were associated with a facility discharge. There were nine factors collected preoperatively, of which two were based on demographics and medical history (i.e., age and the Charlson Comorbidity Index) and seven were obtained from patient-reported outcome measures (i.e., the Risk Assessment and Prediction Tool score and individual question responses, the Patient-Reported Outcomes Measurement Information System (PROMIS-10) T-scores for physical function and mental health, and the results of the Brief Resiliency Scale). There were three inpatient variables (i.e., ambulation distance, length of stay, and timed up-and-go results) also noted to be significantly associated with a facility discharge. Patients who had five preoperative factors, or eight factors overall, were most likely to be discharged to a facility. The results of this study indicated that a patient's mental health, mobility, and support structure at home are the most influential factors associated with a facility discharge. Additionally, the results suggested that the patient-reported outcomes measures provide a significant discriminatory ability to identify patients at risk for a facility discharge following a primary total joint arthroplasty.

Histopathological Characteristics of Zonular Fibers and Lens Capsule and Their Relationship to Clinical Features in Intraocular Lens Dislocation

Purpose: To identify the histopathologic changes in the lens capsule of eyes with in-the-bag intraocular lens (IOL) dislocation. Design: Pathological analysis and correlation with clinical findings. Setting: Hayashi Eye Hospital (Fukuoka, Japan). Methods: Specimens of twenty-five IOL-lens capsule complexes obtained during surgery were processed for scanning electron microscopy (SEM). Backscattered electron images of cross-sections of the lens capsule were obtained using SEM. Ultrastructural changes in the lens capsule were examined and analyzed based on preoperative clinical findings. Results: The mean age was 70.0±18.0 years. The mean time from initial cataract surgery to IOL removal was 12.5±7.0 years. Of these, nine eyes had exfoliation syndrome (XFS), seven had high myopia, five underwent vitrectomy, and three had atopic dermatitis. The mean age of the XFS cases was 86.6±4.3 years. All XFS specimens demonstrated highly associated ruptured zonular fibers (p <.01). In the 16 non-XFS cases, the mean age was 61.2±17.5 years, significantly younger than in the XFS cases (p <.01); 14 of the 16 specimens had a detachment of zonular lamella (ZL), which was highly associated (p <.01). Four non-XFS eyes exhibited clear capsules, demonstrating significant associations with capsular delamination (p < .01) and the absence of lens epithelial cells (p < .01), resembling dead-bag syndrome. Conclusions: Structural changes in the lens capsule associated with IOL dislocation are mainly of three types: ruptured zonular fibers in XFS, detachment of the ZL, and capsular delamination. They vary according to the associated diseases, suggesting that prevention and treatment should consider the underlying pathophysiology.

Insights into the effects of subretinal voretigene neparvovec-rzyl in RPE65-associated Leber congenital amaurosis: an 18-Month report.

Assess safety and effectiveness of subretinal gene replacement therapy at 18 months post treatment. Retrospective, longitudinal study conducted at the Hospital for Sick Children in Toronto, Canada. Patients with bi-allelic RPE65 variants, early onset retinal degeneration, and residual viable retina who underwent voretigene neparvovec r-zyl gene replacement therapy. Data collected included demographic information, molecular genetic results, and comprehensive ocular assessment results from preoperataive and postoperative visits up to 18 months. To assess the treatment's efficacy, postoperative best corrected visual acuity, full-field stimulus test (FST), visual field (VF) area, optical coherence tomography, and global satisfaction were compared to preoperative findings. The procedures were safe with no complications. There was no significant improvement in visual acuity. Three eyes showed a slight reduction in VF area. All showed a reduction in ellipsoid zone thickness and area, but the outer nuclear layer thickness and area were stable. All had a significant improvement in retinal sensitivity, as per FST, allowing better navigation in a dim environment. All 3 patients reported being "very satisfied". Following a safe gene replacement therapy, the 3 first Canadian cases had an improvement in retinal sensitivity as per FST, and our patients described their experience as positively life changing.

Compartmental location of middle ear inflammatory polyps in cats: 9 cases (2021-2023).

To report the compartmental location of feline aural inflammatory polyps within the tympanic bulla. Nine client-owned cats with clinical signs and middle ear filling consistent with feline aural inflammatory polyps were prospectively pre-selected and underwent unilateral or bilateral ventral bulla osteotomy. Preoperative and surgical findings, complications and outcomes were recorded. Tissues obtained from the ventromedial compartment and from the dorsolateral compartment of the tympanic bulla were submitted separately for histological examination. Definitively selected cats were those having feline aural inflammatory polyps in at least one compartment of their operated tympanic bulla. Ten ventral bulla osteotomies were performed on nine cats. Feline aural inflammatory polyps were histologically diagnosed in both compartments of all tympanic bullas. There were no intraoperative complications. Apart from Horner's syndrome on the ipsilateral eye following surgeries, post-operative complications were rare. This is the first study that documents the presence of feline aural inflammatory polyps in both compartments of the tympanic bulla in all cats with aural involvement. Should a complete excision of feline aural inflammatory polyps be desired, complete debridement of both compartments of the tympanic bulla is required. Traction-avulsion techniques using approaches of tympanic bulla with no visit of the ventromedial compartment may not completely resolve the condition.

Correlation of endoscopic third ventriculostomy with postoperative body temperature elevation: a single-center retrospective comparative study

Postoperative fever following neuroendoscopic procedures has been well-documented, yet specific differentiation based on the nature and site of the procedure remains lacking. Given the anatomical involvement of the hypothalamus in temperature regulation, we propose that endoscopic third ventriculostomy (ETV) may have a distinct impact on postoperative fever. This study aims to investigate this phenomenon. This retrospective comparative analysis includes all patients who underwent neuroendoscopic procedures between January 2017 and September 2023. Patients were divided into ETV and non-ETV groups, and comparisons were made regarding postoperative body temperature during the initial 7 days after surgery. Comprehensive data were collected on case numbers, surgical duration, symptoms, treatments, and outcomes. Body temperature was measured postoperatively in the morning and evening for 7 days, with elevated temperature categorized as sub-fever (37.5 to 38.2 °C) and fever (≥ 38.3 °C). 207 patients underwent neuroendoscopic procedures in our neurosurgical centers (median age19.1 ± 21.7 years, 50.7% male), primarily for aqueduct stenosis (25.6%) and intra- and periventricular tumors (25.1%). Among them, 104 (50.2%) patients underwent ETV, while 103 (49.8%) underwent other neuroendoscopic procedures (43.7% intracranial cysts fenestrations, 39.8% placement of intraventricular catheters, 3.9% intraventricular lavage, 4.9% septostomy, and 5.8% tumor biopsy). All postoperative infections were excluded. No significant differences were observed in preoperative symptoms, laboratory findings, or postoperative antibiotic usage between the two groups. The ETV group exhibited significantly more postoperative fever (37.5% vs. 19.4%, p = 0.005), particularly from the first night to the third night after the operation. This study substantiates the hypothesis that manipulation of the floor of third ventricle through endoscopic ventriculostomy may contribute to postoperative fever, rather than the neuroendoscopic procedure. Elevated temperatures were observable from the first night post-surgery and typically normalized by third day without necessitating specific treatment. Further prospective studies are warranted to elucidate the precise mechanisms underlying intraoperative manipulation.

Osteoid Osteoma in an Elderly Patient: Diagnostic Challenges.

Osteoid osteoma is a benign bone tumor commonly affecting young individuals, with a rare occurrence in older adults. It typically presents with night pain relieved by nonsteroidal anti-inflammatory drugs and is characterized radiographically by a small, radiolucent nidus surrounded by reactive sclerosis. We present a 70-year-old female patient with persistent right hip pain, initially diagnosed as arthritis, who underwent total hip arthroplasty. Preoperative imaging findings were inconclusive, showing edema and degenerative changes without a definitive lesion. Histopathological examination of the arthroplasty specimen revealed a nodule consistent with osteoid osteoma. This report highlights the diagnostic challenge of osteoid osteoma in elderly patients, where symptoms may be atypical and overlap with other conditions like osteoarthritis.

Unicentric Castleman's Disease of Paraspinal Origin Requiring Differentiation From Schwannoma: Case Report.

Unicentric Castleman's disease (UCD) typically presents as an asymptomatic tumour in the anterior or middle mediastinum. Occurrence in the paravertebral region is comparatively rare and it requires differentiation from neurogenic tumours by imaging. In our patient, preoperative imaging findings were atypical of schwannoma. Contrast-enhanced MRI of the thoracic region showed a muscle-like mass in contact with the pleura on T1-weighted images. T2-weighted images showed high signal, especially at the margins. Diffusion-weighted images showed diffusion restriction around the limbus, and contrast-enhanced T1-weighted images displayed strong enhancement of the mass. Diagnosis could not be made preoperatively, although UCD was suspected. Thoracoscopic tumour resection was performed for definitive diagnosis and treatment and postoperative diagnosis was hyaline-vascular-type UCD. Diagnosis of neurogenic tumours can be difficult by imaging alone. When imaging findings are atypical, a definitive diagnosis is required, with consideration of the possibility of UCD.

Robot-Assisted PSMA-Radioguided Salvage Surgery for Oligorecurrent Prostate Cancer Using the Novel SENSEI® Drop-in Gamma Probe: Correlation of Intraoperative Measurements to Preoperative Imaging and Final Histology.

To examine the feasibility and safety of the SENSEI® drop-in gamma probe for robot-assisted, prostate-specific membrane antigen (PSMA)-radioguided salvage surgery (RGS) in lymph node or local oligorecurrent prostate cancer (PCa), detected via PSMA positron emission tomography/computed tomography (PET/CT). The first thirteen patients with pelvic oligorecurrent PCa who underwent [99mTc]Tc-PSMA-I&S RGS using the SENSEI® drop-in gamma probe at the Martini-Klinik (February-June 2024) were retrospectively analyzed. Radioactivity measurements in counts per second (CPS) as absolute values or ratios (CPS of tumor specimens/mean CPS from the patients' benign tissues) were correlated with preoperative imaging and pathological findings (benign/malignant, lesion size). Postoperative complete biochemical response (cBR) was defined as prostate-specific antigen (PSA) levels of <0.2 ng/mL. Fifty-four specimens were removed from 13 patients, with nineteen (35%) containing PCa. All patients had one PSMA PET/CT-positive lesion, which were all detected intraoperatively. These lesions showed higher ex vivo CPS, CPS ratios, and larger cancer diameters than PSMA PET/CT-negative lesions (all p < 0.05). Cancer-containing specimens exhibited higher CPS and CPS ratios than benign tissues (median values of 45 vs. 3, and 9.9 vs. 1.0, both p < 0.001). In total, 12/13 (92%) patients achieved cBR. This device yielded excellent detection rates with good correlation to preoperative imaging and histological results without adverse events.

Robot-Assisted Laparoscopic Sacrohysteropexy with Autologous Fascia Lata.

Autologous fascia lata has been increasingly utilised in pelvic floor reconstructive surgeries such as sacrocolpopexy and sacrohysteropexy. This case highlights sacrohysteropexy with autologous fascia lata as a promising option for women with advanced uterovaginal prolapse who wish to preserve their uterus and avoid synthetic mesh. We report the case of a 65-year-old woman with stage 3 pelvic organ prolapse following one forceps and one spontaneous vaginal delivery. She presented with cervical-dominant prolapse (6cm beyond the hymen) and a widened genital hiatus. She was initially managed with a Gellhorn pessary for 7months, which was removed before surgery. Preoperative findings included prolapse of the cervix, anterior, and posterior vaginal walls (+ 1cm distal to the hymen). A robot-assisted laparoscopic sacrohysteropexy with autologous fascia lata was performed. The 120-min procedure, conducted by a certified urogynaecologist, began with harvesting a 12 × 4cm autologous fascia lata graft from the left thigh. The graft site was closed with 2-0 absorbable sutures and supported with a compression bandage for 4weeks. The graft was secured to the cervix and anterior longitudinal ligament through laparoscopic dissection and robot-assisted suturing. No perioperative complications occurred, and the patient was discharged on postoperative day 2. At 1-year follow-up, there was no recurrence of prolapse. Sacrohysteropexy using autologous fascia lata is a feasible and effective alternative to synthetic mesh, providing an additional surgical treatment option for women in settings where synthetic polypropylene meshes are not approved, contraindicated, or an unacceptable option.

Assessing Malignant Risk in B3 Breast Lesions: Clinical Insights and Implications

Background/Objectives: B3 breast lesions, characterized by uncertain malignant potential, pose a significant challenge for clinicians. With the increasing use of preoperative biopsies, there is a need for careful management strategies, including watchful waiting, vacuum-assisted excision (VAE), and surgery. This study aims to assess the concordance between preoperative biopsy findings and postoperative histology, with a focus on evaluating the positive predictive value (PPV) for malignancy in B3 lesions. Methods: Over a seven-year period, 305 patients preoperatively diagnosed with B3 lesions were treated at the Multidisciplinary Breast Center of “Fondazione Policlinico Universitario Agostino Gemelli IRCCS” in Rome. All cases were reviewed at multidisciplinary meetings involving surgeons, radiologists, histopathologists, and oncologists. Preoperative diagnoses were obtained by ultrasound-guided core needle biopsies (CNBs) or stereotactic-guided vacuum-assisted biopsies (VABs). The radiological features were assessed using the Breast Imaging Reporting and Data System (BIRADS), and discrepancies between radiological and pathological findings were recorded. The biopsy results were compared with the postoperative histological findings to calculate the PPV for malignancy. Results: Of the 305 B3 lesions biopsied, 242 were confirmed as B3 on the final histological examination, resulting in a concordance rate of 79.3%. A total of 63 cases were upgraded to malignancy on postoperative histology, yielding a cumulative upgrade rate of 20.7%. The PPV for malignancy was 31.5% for atypical ductal hyperplasia (ADH), 27.6% for lobular neoplasia (LN), 22.9% for papillary lesions (PLs), 12.1% for flat epithelial atypia (FEA), 10.4% for radial scar (RS), and 10.3% for phyllodes tumors (PTs). Conclusions: Our findings demonstrate that the cumulative PPV for B3 lesions, as well as the PPV for each subtype, are consistent with the existing literature. The factors influencing the PPV include the use of CNB versus VAB, discordance between the BIRADS and biopsy results, the presence of atypia in the biopsy sample, the presence of microcalcifications on mammography, mass lesions identified on MRI, and the extent of the lesion. These factors should be considered in the personalized management of B3 lesions, potentially leading to more targeted and less invasive approaches in the future.

A Study of the Comparison Between Preoperative Ultrasonography Findings With Intraoperative Observations in Laparoscopic Cholecystectomy.

This study aims to evaluate the accuracy of ultrasonography (US) by comparingpreoperative ultrasonographic findings with intraoperative observations during laparoscopic cholecystectomy (LC). An observational analytical study was conducted at a tertiary hospital in Pune over two years and included 98 patients aged 20-80 with symptomatic cholelithiasis confirmed by US. Preoperative parameters assessed included gallstone number, gallbladder volume, wall thickness, and pericholecystic fluid. These were compared to intraoperative findings during LC. Data were analyzed using SPSS Statistics for Windows, Version 16 (Released 2007; SPSS Inc., Chicago, Ill), with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) calculated for the US parameters. The mean patient age was 44.14±15.06 years, with a female predominance (70%). US showed high sensitivity (78.13%) but low specificity (35.29%) for detecting the number of stones, and showed high specificity (100%) but low sensitivity (21%) in the assessment of gallbladder wall thickness. For detecting gallbladder distension, UShad a sensitivity of 69.7% and a specificity of 11.1%, while itachieved perfect sensitivity and NPV (100%) for evaluation of pericholecystic fluid. Preoperative US provides valuable insights for surgical planning, with high sensitivity and specificity for gallbladder wall thickness and pericholecystic fluid. However, its accuracy in detecting the number of stones and gallbladder distension is moderate. US can be considered a useful investigation for diagnosing cholelithiasis. It may be used topredict the fate of LC, but further studies need to be carried out to confirm its surgical importance.

Frontalis sling surgery - pediatric versus adult population: characteristics and outcomes

PurposeFrontalis sling surgery is a common method for ptosis correction for both pediatric and adult populations. This study aims to compare the characteristics and outcomes of this surgery in these two populations.MethodsA retrospective cohort study. Patients who underwent frontalis sling surgery between the years 2009 and 2024, with complete medical chart data, and had at least a one-month follow-up period were included. Age, gender, ptosis type, type of sling, complications, and re-surgery were analyzed.ResultsA total of 62 patients were included, with 41 patients in the pediatric group and 21 patients in the adult group. The mean age was 4.7 ± 5.0 and 46.04 ± 18.33 years old in the pediatric and adult groups, respectively. The most common etiology of ptosis in the pediatric group was simple congenital (70%), while the most common etiology in the adult group was myogenic ptosis due to a systemic condition (47%) (p < 0.001). Baseline pre-operative MRD1 (marginal reflex distance 1) was lower in the adult group compared to the pediatric ( -0.37 ± 1.21 mm vs. 0.36 ± 0.65 mm respectively (t-test, p = 0.04)). However, the mean change in MRD1 (pre-operative to postoperative) was not significantly different for both groups (t-test, p = 0.5). A higher rate of sling extrusion was observed among the adult group (0% of pediatrics vs. 14% of adults, chi-square, p = 0.013). A higher number of previous sling surgeries were found to be positively correlated (r = 0.672) with overall postoperative complications (Pearson correlation. p = 0.006).ConclusionFrontalis sling surgery varies between adult and pediatric patients regarding etiology, preoperative findings, surgical approach, and complications. Adults experienced higher rates of complications such as sling extrusion and dry eye. Moreover, an increased number of previous sling surgeries was associated with a rise in postoperative complications such as suture dehiscence, extrusion, and granuloma formation. Consequently, frontalis sling procedures should be regarded as a last resort for ptosis correction in adults due to the elevated risk of complications.

Prediction and Estimation of Postoperative Refractive Error in Phacoemulsification: Using Ultrasound A-Scan and Intra Ocular Lens Master

Background: This study aims to predict and estimate the postoperative refractive outcome in participants undergoing phacoemulsification using IOL Master and A-scan biometry.Methods: A cross-sectional study was done where ninety eyes of 90 participants undergone phacoemulsification using SRK/T formula were included in longitudinal research. Each participant underwent axial length (AL) measurement by IOL Master and A-scan, and keratometry reading (k- reading) by manual TOPCON keratometer and automated keratometer on IOL master for IOL power calculation. All the pre-operative measurements between A-scan and IOL master and two keratometers were compared using paired-t tests. The four-week postoperative refractive error was estimated using univariate analysis and its prediction was compared with the ocular biometry parameters using quadratic regression.Results: Preoperative findings were higher for AL and ACD by IOL master and A-scan (0.27±0.14mm; p&lt;0.001, 0.14±0.31mm, p&lt;0.001) respectively. The AL and K-reading were found to be strong predictors of IOL power calculation (β = -1.07; p&lt;0.001, β = 0.75; p&lt;0.001), respectively. The AL, K-reading were found to be strong predictors for four-week postoperative refractive error (β = -1.563; p = 0.012, β = 1.052; p = 0.012) where postoperative error was found to be higher (F = 7.521, p&lt;0.001) in A-scan than IOL Master. For K-reading, the two keratometer’s and for AL by A-scan and IOL Master’s level of agreement (95% LoA) was comparable (-0.15 to 0.12mm and -0.01 to 0.54mm). Conclusions: IOL Master is more reliable for ocular biometry and minimizes postoperative refractive error.Keywords: Axial length; intraocular lens power; keratometry-reading; refractive error estimation; postoperative refractive error.

Association Between Preoperative Radiological Findings and Outcomes After Total Knee Arthroplasty.

Introduction Total knee arthroplasty (TKA) is a widely accepted surgical intervention for patients with advanced knee osteoarthritis, aimed at reducing pain and improving functional mobility. Preoperative radiological evaluations, including assessments of joint space narrowing, osteophytes, varus/valgus deformities, and subchondral sclerosis, are essential for planning the surgery and predicting postoperative outcomes. Although extensive research has been conducted internationally, data focusing on populations in Saudi Arabia remain limited. This study investigates the association between preoperative radiological findings and postoperative outcomes, including pain, range of motion (ROM), and functional status, in a Saudi retrospective cross-sectional study. Methods This retrospective cross-sectional study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. A total of 523 patients who underwent TKA were included. Data were collected from medical records through the BESTCare system, focusing on patient demographics, preoperative and postoperative radiological findings, and surgical outcomes. Statistical analyses were performed using IBM SPSS Statistics software (IBM Corp., Armonk, NY), and the significance was determined at p < 0.05. Results The study population had a median age of 64 years, and 72% were female. Preoperative radiological findings included varus deformity (65.39%), joint space narrowing (47.61%), and osteophytes (31.17%). Postoperative outcomes showed 19% of patients reported pain, 85% regained normal ROM, and 74% returned to normal functional status. Significant associations were found between postoperative limited ROM and preoperative osteophytes (p = 0.021), subchondral sclerosis (p = 0.033), and osteopenia (p = 0.017). Subchondral sclerosis was also linked to postoperative functional impairment (p = 0.009). No significant association was observed between preoperative radiological findings and postoperative pain or thromboembolism. Conclusion Preoperative radiological markers, particularly osteophytes and subchondral sclerosis, were significant predictors of postoperative ROM and functional status in TKA patients. Identifying these markers can enhance preoperative planning, enable targeted rehabilitation strategies, and improve patient outcomes in the Saudi population. Further studies are warranted to confirm these findings and explore additional predictive factors.

Long-Term Results after Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 10-Year Cohort Study.

A gold standard surgical treatment for osteochondral lesions (OCLs) of the talus still needs to be established. Still, autologous matrix-induced chondrogenesis (AMIC) is a commonly applied 1-stage procedure that has achieved good short- and mid-term results. The present cohort study aimed to assess whether the long-term, 10-year results can confirm the previous findings. All patients underwent an open AMIC procedure using a collagen type I/III bilayer matrix for a talar OCL. General demographic data, preoperative magnetic resonance imaging findings, intraoperative details, and German version of the Foot Function Index (FFI-D) scores preoperatively and at 1, 5, and 10 years as well as European Foot and Ankle Society (EFAS) and American Orthopedic Foot & Ankle Society (AOFAS) scores at 10 years after surgery were analyzed. The primary outcome variable was the procedure's longitudinal effect, and several variables' influence on the outcome was tested. Of 47 consecutive patients, 18 (38%) were included. Of the 18 patients, 6 (33%) were female, and 12 (67%) were male, with a mean age of 39 ± 15 (range = 15-62) and an average body mass index (BMI) of 26 ± 5 (range = 20-38) kg/m². The mean defect size was 1.4 ± 0.9 (range = 0.2-4) cm². The FFI-D total score showed a significant decrease from preoperatively to 1 year postoperatively (56 ± 19 to 34 ± 27; P = 0.001) with a further nonsignificant decrease to the 5-year (34 ± 27 to 21 ± 20; P = 0.16) and 10-year follow-up (21 ± 20 to 15 ± 13; P = 1.00). All the single items decreased significantly from preoperatively to the 5- and 10-year mark. Although not significant, most items improved from 5 to 10 years postoperatively. Age positively correlated with the preoperative, 5-year, and 10-year follow-up FFI-D total score. AMIC, as a single-step surgical intervention, is a viable long-term treatment option. Patient selection regarding symptoms and findings is vital to achieve satisfying results.

Risk Factors for de Novo Postoperative Urinary Retention in Posterior Lumbar Spine Surgery.

Retrospective cohort study. De novo postoperative urinary retention (POUR) after lumbar posterior decompression surgery for lumbar spinal canal stenosis (LSCS) is a statistically known but uncommon complication for both patients and spine surgeons. The aim of this study is to review clinical data and imaging findings and identify preoperative predictors of de novo POUR. The subjects were 738 surgically treated patients with LSCS, without preoperative bladder dysfunction or perioperative complications. Univariate and multivariate analyses using propensity score matching were performed to identify prognostic factors for POUR lasting for at least 1week after postoperative urinary catheter removal. POUR occurred in 23 patients (3.1%). The median recovery time was 41days and only 12 patients (52.2%) showed improvement within 3months. Patients with POUR were significantly older, and the lumbar Cobb angle, location of compressed dura mater (ventral or dorsal), and type of cauda equina redundancy (curve-type) were identified as independent prognostic factors. POUR had no association with sex, comorbidities, surgical procedures, number of decompressed segments, or degree of dura mater compression. This study suggests that older age and curve-type stenosis with ventral or dorsal compression of the dura mater are risk factors for development of de novo POUR. Such preoperative imaging findings may indicate a higher risk of intraoperative thermal and nerve injuries, and possible uneven cauda equina flow improvement after decompression.