Preoperative Examination Findings Research Articles

Corneal Collagen Cross-linking for Keratoconus in Pediatric and Developmentally Delayed Patients.

Corneal cross-linking (CXL) is the standard of care in patients with keratoconus but presents unique challenges in children and developmentally delayed patients. We present our clinical decision-making algorithm, CXL surgical technique, and outcomes in these groups. A retrospective chart review was undertaken at a tertiary referral center of all patients who underwent CXL for keratoconus at University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh between October 1, 2017, and April 1, 2021. Demographic information along with preoperative, intraoperative, and postoperative ophthalmic examination findings were collected. The main outcome measures were indications of CXL, postoperative complications, and visual acuity (VA). Forty-eight eyes of 34 patients [21 patients (30 eyes) with developmental delay (DD) and 13 patients (18 eyes) with no DD (NDD)] underwent epithelium-off, standard CXL. General anesthesia was used for CXL in all patients except for 3 with NDD. A temporary central tarsorrhaphy was performed in all patients with DD and 7 patients with NDD. The remaining got a bandage contact lens. There were no immediate postoperative complications. A trend toward improvement in VA was noted postoperatively. The mean logMAR VA (with habitual correction) was 0.67 preoperatively and 0.57 postoperatively (P = 0.3) in DD and 0.52 and 0.36, respectively (P = 0.13), in NDD. This retrospective review presents a technique for assessment and treatment of keratoconus in children and those with DD. Our technique ensures timely diagnosis and provides a safe method for CXL in these groups. Temporary central tarsorrhaphy is a well-tolerated option to reduce postoperative pain.

Comparison of Long-Term Postoperative Outcomes of the Subtypes of Chronic Rhinosinusitis with Nasal Polyps.

(1) Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition that significantly impacts the health-related quality of life (HRQOL) of patients. This study aims to investigate the disparities in preoperative examination findings, postoperative HRQOL, and disease control status based on CRSwNP subtypes. (2) Methods: A retrospective analysis was conducted on 202 patients who underwent endoscopic sinus surgery for CRSwNP. The study assessed clinical characteristics, blood eosinophil and immunoglobulin E (IgE) levels, modified Lund-Kennedy and Lund-Mackay scores, and Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scores. HRQOL was evaluated using the Sino-nasal Outcome Test (SNOT-22) scores, and disease control status was assessed based on the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 guidelines. (3) Results: Of the 202 patients, Eosinophilic CRSwNP patients exhibited significantly higher preoperative peripheral blood eosinophil ratios and IgE levels, and JESREC scores (p < 0.05). Two years postoperatively, patients in the non-eosinophilic group showed significantly improved SNOT-22 scores compared to preoperative scores (p = 0.007). Notably, the proportion of patients with uncontrolled disease was significantly higher in the eosinophilic group (p = 0.035). Logistic regression analyses identified preoperative SNOT-22 scores and eosinophilic CRSwNP subtype as influential factors on disease control status (p < 0.05). (4) Conclusions: Patients with more severe preoperative symptoms and eosinophilic CRSwNP demonstrated poorer long-term treatment outcomes.

Dysplastic aberrant left subclavian artery originating from a thoracic intersegmental artery associated with a right aortic arch.

A right aortic arch (RAA) is a rare vascular anomaly that often coexists with an aberrant left subclavian artery (ALSA). Due to the rarity of RAA, the development of an ALSA is not well understood. We describe a case in which a 58-year-old man who was scheduled to undergo posterior decompression and fusion surgery for thoracic ossification of the posterior longitudinal ligament from Th1 to Th3 was found to have a RAA and an ALSA. Preoperative computed tomography angiography demonstrated a RAA and an ALSA. The ALSA was extremely tortuous and ran in the paraspinal muscles behind the thoracic laminae, which meant it was in the surgical field. The ALSA arose from the descending aorta and bifurcated into the left segmental arteries of Th1 and Th2, and also bifurcated into the left vertebral artery, which had a normal subsequent course. The dysplastic ALSA was considered to have developed from the thoracic intersegmental artery. Based on preoperative examination findings, we performed spinal surgery without vessel injury. We report a rare case of a dysplastic ALSA that developed from the thoracic intersegmental artery with a RAA. The knowledge of this anomaly provides safety in spinal surgery of the cervicothoracic junction.

Electrodiagnostic severity does not predict short- to midterm outcomes of cubital tunnel release surgery

This study aimed to explore the prognostic value of electrodiagnostic studies (EDS) to clarify their utility in clinical practice prior to cubital tunnel release surgery and to identify patient factors associated with patient-reported functional improvement after surgery. Our hypothesis was that patients with severe preoperative findings on EDS will tend to experience less functional improvement after surgery given the extent of ulnar nerve compressive injury. Patients with cubital tunnel syndrome and preoperative electrodiagnostic data treated from 2012 to 2022 with cubital tunnel release were assessed regarding demographic information, preoperative physical examination findings, EDS findings, postoperative complications, and patient-reported outcomes. Short- to midterm quick Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH) scores were collected for all patients for further evaluation of preoperative EDS data. Patients were grouped into those who had met the minimal clinically important difference (MCID) in delta qDASH at short- to midterm follow-up and those who did not. EDS data included sensory nerve onset latency, peak latency, amplitude, conduction velocity, as well as motor nerve latency, velocity, and amplitude. Electromyographic (EMG) studies were also reviewed, which included data pertaining to fibrillations, presence of abnormal fasciculation, positive sharp waves, variation in insertional activity, motor unit activity, duration of activity, and presence of increasing polymorphisms. Of the 257 patients included, 160 (62.0%) were found to meet the MCID for short- to midterm qDASH scores. There were no significant differences between patients who did or did not meet the MCID regarding baseline demographics, comorbidities, preoperative examination findings, and operative technique. Patients who met MCID tended to have lower complication (3.80% vs. 7.20%, P=.248) and revision (0.60% vs. 4.10%, P=.069) rates, but these findings were not statistically significant. The cubital tunnel severity as determined by the EDS was similar between cohorts (14.1% vs. 14.3%, P=.498). Analysis of EMG testing showed there were no significant differences in preoperative, short- to midterm qDASH, or delta short- to midterm qDASH scores for patients with or without abnormal EMG findings. Multivariate regression suggested that only age (P=.003) was associated with larger delta qDASH scores. Patient-reported preoperative disease severity may predict the expected postoperative change in ulnar nerve functional improvement, and EDS may not have prognostic value for patients undergoing cubital tunnel decompression. Therefore, physicians may suggest surgical treatment without positive EDS findings and still expect postoperative improvement in functional outcomes.

Simplified segmental scleral buckling without localization and cryopexy: A retrospective comparison with conventional segmental scleral buckling

Abstract: PURPOSE: The aim of this study was to propose a simplified segmental scleral buckling (SSSB) technique that does not require break localization for less-experienced vitreoretinal surgeons. MATERIALS AND METHODS: This retrospective study compared the clinical results of 46 conventional and 23 SSSB (conventional segmental SB [CSSB] and SSSB, respectively) procedures in a tertiary referral retinal center in Taiwan between 2008 and 2019. In the CSSB group, breaks were localized during surgery. In the SSSB group, a wider sponge band and a longer scleral buckle were used to maximize the chances of sealing the retinal breaks based on the preoperative fundus examination findings and to minimize the positioning error caused by cyclotorsion, without performing indirect ophthalmoscopy. The primary outcome was assessed after 6 months. Patient characteristics, surgical parameters, and outcomes were compared between groups. The main outcomes were the duration of surgery, changes in visual acuity, primary success rate, rhegmatogenous retinal detachment recurrence rate, and the frequency of further laser photocoagulation. RESULTS: SSSB had a shorter duration than CSSB and was associated with more frequent use of longer and wider explants and need for further laser retinopexy. Both groups showed high primary success rates (95.65%). CONCLUSION: The primary success rates for the SSSB and CSSB groups were comparable and equally high. SSSB required laser retinopexy more frequently and was a shorter procedure.

Combination phacoemulsification and pars plana vitrectomy for retinal reattachment surgery in the Siberian Husky breed.

To report the success rate and complications of combined phacoemulsification and pars plana vitrectomy (PPV) for treatment of cataracts and retinal detachment in the Siberian Husky breed. Client-owned Siberian Husky dogs that underwent combined phacoemulsification and PPV at two veterinary referral centers. Retrospective study of 16 Siberian Husky dogs that underwent combined phacoemulsification and PPV with a minimum 3-month postoperative follow-up. Signalment and preoperative ophthalmic examination findings, intraoperative findings, and postoperative visual status and complications were recorded. Functional success was defined as the maintenance or restoration of vision. Seventeen eyes of 16 dogs were evaluated. Immediate postoperative anatomic success was achieved in all 17 eyes (100%), with functional success through the last known follow-up examination achieved in 88.2% of operated eyes (15/17). The most common postoperative complication was silicone oil migration into the anterior chamber (AC-SiO migration), occurring in 47.1% of eyes (8/17), followed by corneal endothelial decompensation and glaucoma each occurring in 17.6% of eyes (3/17). Combined phacoemulsification and PPV is a viable option in Siberian Husky dogs with cataracts and preoperative retinal detachment. Visual success was achieved in 88.2% of eyes, with the most common postoperative complication being AC-SiO migration.

Comparison of preoperative examination findings and endoanal ultrasonography results with operation findings in perianal fistula disease

Purpose: The aim of the current study was to compare the preoperative examination findings, endoanal ultrasonography results, and operative findings in patients diagnosed with perianal fistula.&#x0D; Materials and Methods: A prospective study was conducted between 2021 and 2022 on patients who underwent surgical treatment for perianal fistula. The patients were recorded and classified according to the Park classification by the surgeon performing the operation. Subsequently, a surgeon with 10 years of endoanal ultrasonography experience reclassified the patients and recorded the findings (Ultrasonographic Evaluation - USE). The surgery was performed by a different surgeon who was blind to the USE results and the final diagnosis was recorded (Evaluation Under Anesthesia - EAU). The preoperative examination findings, endoanal ultrasonography findings, and operative findings were compared postoperatively.&#x0D; Results: The study included 60 patients, with 52 being male and 8 being female, and a mean age of 44.2 ± 12.6 years. The patients were classified as low transsphincteric (TSF), intersphincteric (ISF), and high TSF at ratios of 40%, 33.3%, and 26.7%, respectively (24, 20, and 16 patients, respectively). Endoanal ultrasonography found that 30%, 35%, and 21.7% of patients had low TSF, ISF, and high TSF, respectively (18, 21, and 13 patients, respectively), while postoperatively, 45%, 33%, and 21.7% of patients were classified as low TSF, ISF, and high TSF, respectively (27, 20, and 13 patients, respectively). The ISF rate in preoperative examination findings was significantly higher than in postoperative diagnoses, with intermediate coherence between the two diagnoses (κ: 0.462). The rates of low and high TSF were found to be significantly higher in ultrasonography findings than in postoperative diagnoses, with high coherence between the two (κ: 0.701).&#x0D; Conclusion: Endoanal ultrasonography is important for mapping, especially for transsphincteric fistulas, in the surgical treatment of perianal fistulas.

Prognosis of Traumatic Diaphragmatic Injury in Dhaka Medical College Hospital, Dhaka

Introduction: Diaphragmatic injuries include wounds and diaphragmatic ruptures due to thoracoabdominal blunt or penetrating trauma. Their incidence ranges between 8 and 15%. The diagnosis is often delayed despite several medical imaging techniques. The mortality is mainly related associate Injury. Aims: The aim of our study was to evaluate the prognosis, after surgery of our patient with diaphragmatic injury. Patients and methods: We performed a prospective study over a period of two years, between January 2018 December 2019, at the department of thoracic surgery of Dhaka Medical College Hospital, Dhaka, Bangladesh. All patients diagnosed with diaphragmatic injury were included in this study. Each patient operated because traumatic diaphragmatic injury was evaluated in respect of age, sex, nature of injury, preoperative examination findings, laboratory test results, imaging methods, time of diagnosis, operation findings, concomitant injures to other organs, operations performed, length of stay in hospital and development of postoperative morbidity and mortality. Results: Over the study period, 22 cases of diaphragmatic injuries were included. The female was 4 and 18 was male. The mean age of male patients 29.2±12.1 and female 28±11.6 years. RTA with blunt trauma chest was 12, 6 was fall from height and 5 were stab injuries. The most common injuries concomitant to traumatic diaphragmatic rupture were a haemothorax, rib fracture, stomach, colon, liver and spleen. Three patients developed wound infection and two patients died. Conclusion: In high energy blunt and penetrating thoracoabdominal trauma, diaphragmatic injures should be suspected. An emergency thoracotomy or laparotomy followed by reposition of abdominal organ and repair of the defect of the diaphragm is the gold standard for the management of these cases. J Dhaka Med Coll. 2021; 30(2) : 131-135

Delayed postoperative hyponatremia in patients with acromegaly: incidence and predictive factors.

Delayed postoperative hyponatremia (DPH) is a unique complication of transsphenoidal surgery (TSS) in pituitary tumors. Growth hormone (GH) enhances renal sodium reabsorption; however, the association between postoperative GH reduction and DPH in acromegaly is unclear. This study was performed to clarify the incidence of and the predictive factors for DPH in patients with acromegaly who underwent TSS. Ninety-four patients with active acromegaly were examined retrospectively. During the postoperative course, patients with serum sodium levels ≤ 134mEq/L were classified into the DPH group. We compared basic clinical characteristics, tumor characteristics, and preoperative and postoperative examination findings between the DPH and non-DPH groups. DPH occurred in 39 patients (41.5%), and the lowest serum sodium levels were generally observed during postoperative days (PODs) 7-9. They needed a 3-day longer hospital stay than those without DPH. The DPH group had lower preoperative body weight and body mass index. In addition, a transient increase in body weight during PODs 5-7 occurred with a transient decrease in urinary volume in the DPH group. Preoperative and postoperative GH and insulin-like growth factor-1 levels did not differ between the twogroups. The findings suggested that lower preoperative weight and a postoperative transient gain in body weight are associated with an increased risk of DPH in acromegaly patients undergoing transsphenoidal surgery.

Preoperative ultrasound combined with routine blood tests in predicting the malignant risk of pancreatic cystic neoplasms.

Accurate preoperative identification of benign or malignant pancreatic cystic neoplasms (PCN) may help clinicians make better intervention choices and will be essential for individualized treatment. Preoperative ultrasound and laboratory examination findings, and demographic characteristics were collected from patients. Multiple logistic regression was used to identify independent risk factors associated with malignant PCN, which were then included in the nomogram and validated with an external cohort. The Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI) were calculated to evaluate the improvement in the predictive power of the new model with respect to that of a combined imaging and tumor marker prediction model. Malignant PCN were found in 83 (40.7%) and 33 (38.7%) of the model and validation cohorts, respectively. Multivariate analysis identified age, tumor location, imaging of tumor boundary, blood type, mean hemoglobin concentration, neutrophil-to-lymphocyte ratio, carbohydrate antigen 19-9, and carcinoembryonic antigen as independent risk factors for malignant PCN. The calibration curve indicated that the predictions based on the nomogram were in excellent agreement with the actual observations. A nomogram score cutoff of 192.5 classified patients as having low vs. high risk of malignant PCN. The model achieved good C-statistics of 0.929 (95% CI 0.890-0.968, P < 0.05) and 0.951 (95% CI 0.903-0.998, P < 0.05) in predicting malignancy in the development and validation cohorts, respectively. NRI = 0.268; IDI = 0.271 (P < 0.001 for improvement). The DCA curve indicated that our model yielded greater clinical benefits than the comparator model. The nomogram showed excellent performance in predicting malignant PCN and may help surgeons select patients for detailed examination and surgery. The nomogram is freely available at https://wangjunjinnomogram.shinyapps.io/DynNomapp/.

Comparison of laparoscopic cystectomy and fenestration/cauterization procedures in terms of pelvic pain and recurrence in patients with endometrioma

Abstract&#x0D; Introduction: Endometriosis is an estrogen-dependent, progressive inflammatory disease caused by the growth of endometrium-like tissue outside the uterine cavity. In women of reproductive age, it is a prevalent cause of pelvic pain. Surgical intervention may be required in the insufficiency of conservative treatments and laparoscopic procedures should be prioritized for surgery. The objective of our study was to compare the efficacy of laparoscopic fenestration-cauterization and cyst excision in patients with ovarian endometrioma on dysmenorrhea, non-menstrual pelvic pain, dyspareunia, and dyschezia symptoms.&#x0D; Materials and methods: The study comprised 112 patients with endometrioma who underwent laparoscopic surgery and whose data could be obtained. In 76.8% (n=86) of the patients, laparoscopic cystectomy was conducted, and in 23.2% (n=26) of the patients, laparoscopic fenestration+cauterization were performed. The patients' preoperative examination findings and VAS (Visual Analog Scale) pain levels were retrieved retrospectively. Patients were contacted again during the study, VAS pain scores were recalculated, and a gynecological ultrasound scan was performed to check for recurrence. The collected data were analyzed comparatively.&#x0D; Results: The mean age of the patients was 35.5 ± 6.8 years in the fenestration-cauterization group and 32.3 ± 5.9 years in the cystectomy group. 12.5% (n=14) of the cases were classified as stage I, 3.5% (n=4) as stage II, 32% (n=36) as stage III, and 52% (n=58) as stage IV. The operative time was significantly shorter in the fenestration+cauterization group compared to the cystectomy group (respectively/min 50.0±18.4 /61.3.±16.8, p=0.014). In both groups, the number of patients with dysmenorrhea, NMPP, dyspareunia, and dyschezia who had high VAS pain scores decreased significantly (p&lt;0.005). In both procedures, there was no difference between recurrence rates (p=0.801). After surgical treatment, there was a significant decrease in the number of stage III-IV patients with dysmenorrhea and NMPP who had high VAS (p&lt;0.005). &#x0D; Conclusion: We emphasize the significance of laparoscopy in the surgical treatment of endometriosis. Both laparoscopic fenestration + cauterization and laparoscopic cystectomy significantly reduced pain symptoms, especially in patients with advanced endometriosis. The efficacy and recurrence rates of both treatments were not significantly different.&#x0D; Keywords: Endometriosis, endometrioma, pelvic pain, laparoscopic surgery, recurrence

Hydrocephalus in encephalocele.

Encephalocele is a rare congenital neural tube defect (NTD) characterized by herniation of intracranial contents through a defect in the skull. In our study, encephalocele was diagnosed in our clinic and its association with hydrocephalus was evaluated. The effect of this association on the prognosis was discussed. Patients who underwent surgery and follow-up with the diagnosis of encephalocele in the neurosurgery clinic of our hospital in an 8-year period from 2013 to 2021 were retrospectively examined. Patient records were obtained from the case notes of patients who underwent excision and repair for encephalocele. Of the 78 patients included in the study, 88.4% underwent surgery in the neonatal period. Moreover, 47% of the patients are male, and 31% are female. Encephalocele was present in 62.8% of patients and meningocele in 37.2%. Furthermore, 82.1% of encephalocele sacs were located in the occipital region. Chiari type 3 malformation was present in 57.6% of patients. Hydrocephalus developed in 56.4% of patients. There was an additional syndrome in 10.3% of the cases. The most common additional syndromes were corpus callosum dysgenesis with 39.7% and colpocephaly with 29.5%. The additional disease was present in 43.6% of patients. Preoperative and postoperative examination findings of more than half of patients were normal, but 33.3% were apathetic. Furthermore, 67.9% of patients, who underwent complete repair, survived, and 32.1% died. Hydrocephalus was present in 73.5% of patients with encephalocele (p<0.05). Hydrocephalus developed in 77.8% of patients with Chiari type 3 malformation (p<0.05). Hydrocephalus was found in 88.0% of patients with Ex (p<0.05). Encephalocele, which is a subgroup of NTD, differs clinically by its location and accompanying additional anomalies. In encephaloceles, the risk of morbidity and mortality can only be reduced with the multidisciplinary approach. Hydrocephalus and Chiari type 3 malformation are common in patients with encephalocele. These associations adversely affect the prognosis of the disease. Further research should be conducted on the evaluation of risk factors of NTD and methods of prevention from NTD. In this regard, we recommend that the training be repeated at certain intervals and that people's awareness should be raised.

Functional evaluation of distal third tibial fracture osteosynthesis with fix heal TM distal tibial locking plate: An observational study

Background: Fractures around the distal third tibia are one of the challenging problems faced by orthopaedic surgeons owing to associated conditions such as disruption of syndesmosis, fibula fractures, articular extensions, ankle joint dislocations, and compromised soft tissue envelope. The present study is a functional evaluation of the results of the fixHEAL™ locking compression plate for distal tibia fractures.Materials and Methods: We conducted a single-centre study through our post-market surveillance project including data for 56 patients with distal third tibial fractures operated from August 2019- November 2021 was collected. The patient's pre-operative clinical and radiographic examination findings were noted. Orthopaedic procedures were performed by a single surgeon aptly skilled and experienced to handle complex orthopaedic trauma. The functional outcome was assessed by Olerud-Molander functional evaluation score (OMFES). Clinical assessment of bony union and complications in the perioperative and postoperative period was also considered.Results: Radiographic union was observed in all cases by 6 months, except 2 cases where secondary surgery was done to achieve bony union. Conclusion: Functional outcome is influenced by the fracture geometry, co-morbidities, associated soft tissue injury and perioperative complications. Excellent soft tissue handling during surgery and management of associated injuries is a prerequisite for satisfactory results.

Diagnostic performance of ultrasound in assessing the extension of disease in advanced ovarian cancer

Surgical exploration remains the gold standard for evaluating the extension of disease and predicting resectability. A laparoscopy-based scoring model was developed by Fagotti and colleagues in 2006 and updated in 2015, based on the intraoperative presence or absence of some specific cancer features. The model proved an overall accuracy rate of 77% to 100% and is considered the reference test for assessing resectability in our institution. The primary aim of the study was to analyze the agreement between preoperative ultrasound examination and laparoscopic findings in assessing the extension of intraabdominal disease using 6 parameters described by Fagotti's score. This was a prospective single-center observational study. Between January 2019 and June 2020, consecutive patients with clinical or radiological suspicion of ovarian or peritoneal cancer were assessed with preoperative ultrasound examination and assigned a score based on the 6 Fagotti score parameters (great omentum, liver surface, lesser omentum/stomach/spleen, parietal peritoneum, diaphragms, bowel disease). Presence of mesenteral retraction of the small bowel and miliary carcinomatosis on the serosa were also evaluated. Each parameter was correlated with laparoscopic findings. Concordance was calculated between ultrasound and laparoscopic parameters using Cohen's kappa. Cohen's kappa ranged from 0.70 to 0.90 for carcinomatosis on the small or large bowel, supracolic omentum, liver surface, and diaphragms. Cohen's kappa test was lower for carcinomatosis on the parietal peritoneum (k=0.63) and on the lesser omentum or lesser curvature of the stomach or spleen (k=0.54). The agreement between ultrasound and surgical predictive index value (score) was k=0.74. For the evaluation of mesenteral retraction and miliary carcinomatosis, the agreement was low (k=0.57 and k=0.36, respectively). The results of ultrasound and laparoscopy in the assessment of intraabdominal tumor spread were in substantial agreement for almost all the parameters. Ultrasound examination can play a useful role in the preoperative management of patients with ovarian cancer when used in dedicated referral centers.

Serratus anterior dysfunction examination: wall push-up or shoulder flexion resistance test?

BackgroundWall push-up is the most common examination used for the diagnosis of scapular winging secondary to serratus anterior dysfunction. The wall push-up test (WPUT) however may not be able to differentiate causes of scapulothoracic abnormal motion (STAM) or winging. We introduce a novel physical examination maneuver, the shoulder flexion resistance test (SFRT), and we propose that this test is more specific and accurate in determining serratus anterior dysfunction as the cause of STAM.MethodsFifty patients with STAM are included in this study. All patients underwent clinical scapular examination using both WPUT and SFRT. The SFRT is performed by resisting shoulder flexion while the elbow is fully extended at 30°, 60°, and 100°. All patients additionally received preoperative electromyography. All patients underwent exploration and intraoperative stimulation of the distal serratus anterior to characterize color, thickness, and contractility at the time of their arthroscopic pectoralis minor release and scapulopexy or tendon transfer if the serratus was paralyzed. The preoperative clinical examination findings were then correlated with intraoperative findings.ResultsAbnormal distal serratus anterior was seen intraoperatively in 5/50 patients (10%) with marked alterations in color, thickness, and contractility. All (n = 50) patients had positive WPUT manifested by increased winging of the scapula off the chest wall (STAM) with 45 false positive tests. The WPUT was 100% (95% confidence interval [CI] 47.82%-100%) sensitive but 0% (95% CI 0%-7.87%) specific for lower serratus anterior deficiency. The SFRT was 100% sensitive (95% CI 47.82%-100%) and 100% specific (95% CI 92.13%-100%) for serratus anterior dysfunction as the cause of STAM. Using area under the curve (AUC) of receiver operating characteristic (ROC) curves for WPUT and SFRT tests, WPUT had clinically insignificant accuracy (AUC 0.5) compared to the excellent accuracy (AUC 1.0) of SFRT.ConclusionSFRT is specific and accurate in determining serratus anterior dysfunction as a cause of STAM. Based on this study, the SFRT should replace the WPUT as the physical exam of choice to determine dysfunction of the serratus anterior muscle and guide operative management of STAM.

The Relationship Between Parametrial Involvement and Parametrial Tissue Removed in Radical Surgery in Early-Stage Cervical Cancer.

BackgroundThe study aims to evaluate the effect of parametrial dimensions on the prognosis of cases who underwent type 3 radical hysterectomy or radical trachelectomy in early-stage cervical cancer (stage I - IIa).MethodsMedical reports of patients with early-stage cervical cancer who have undergone surgery between 1998 and 2020 in Akdeniz University Faculty of Medicine Gynecological Oncology Clinic were reviewed retrospectively. A total of 292 cases were identified and included in the study. Demographic characteristics, preoperative examination findings, operation records, and pathology results of the cases were reviewed.ResultsParametrial involvement was found histopathologically negative in 244 out of 292 patients included in our study, the remaining 48 (16.4%) patients were found to be positive. The mean length of the right and left parametrium in the group with negative parametrium invasion, who had an average follow-up of 131.2 (0.57 - 268.2) months, was 3 cm, while the mean volume of the right and left parametrium was 7.2 (0.52 - 32) cm3 and 6 (0.48 - 34) cm3, respectively. On the other hand, the mean length of the right and left parametrium was 3 (1.5 - 5.5) cm and 3 (1.4 - 7) cm, respectively, while the mean volume of the right parametrium was 5.55 (1.37 - 22) cm3, and the mean volume of the left parametrium was 7.5 (1.35 - 24) cm3 in 48 patients with positive parametrial invasion. No statistically significant difference was detected between the two groups when compared in terms of parametrial sizes and volumes (P values of 0.061, 0.262, 0.391, and 0.468, respectively).ConclusionsRadical surgical approach is necessary to obtain a tumor-free surgical margin in the surgical treatment of early cervical cancer, but the complications leading to morbidity and mortality are also increasing with this radicality. For this reason, we consider that it is important to adapt the dimensions of the removed parametrium according to the factors affecting recurrence in cervical cancer to obtain more appropriate surgical margins with the least complications.

Outcomes of Femtosecond Laser-Assisted Cataract Surgery Compared to Conventional Phacoemulsification in Eyes with Pseudoexfoliation Syndrome

ABSTRACT Objective To compare the outcomes including complications, in a large cohort of eyes with pseudoexfoliation syndrome that underwent Femtosecond Laser-Assisted Cataract Surgery (FLACS) versus conventional phacoemulsification. Design Retrospective cohort study. Participants A total of 513 eyes from 366 patients with pseudoexfoliation syndrome that underwent cataract surgery between April 1, 2014, and December 31, 2018. Methods Charts were reviewed for preoperative examination findings, intraoperative complications, and post-operative outcomes. Best-corrected visual acuity (BCVA) was measured by logMAR and compared between groups at one month and the final follow-up visit. Results Of 513 eyes, 71 (13.8%) underwent FLACS, and 442 (86.2%) eyes underwent conventional cataract surgery. Between the two groups, there was no difference in the incidence of vitreous prolapse, capsular tear, pupillary expansion device usage, capsular tension support device usage, or postoperative cystoid macular edema (p > .05 for all). At the final visit, there was no significant difference in BCVA between FLACS and conventional phacoemulsification groups (mean logMAR 0.26 vs. 0.25, p = .87). Conclusions When comparing FLACS and conventional phacoemulsification in eyes with pseudoexfoliation syndrome, no difference was seen in the incidence of complications. BCVA was comparable between the two groups. Zonular weakness significantly increased the risk of complications in both groups.

Accuracy of the International Consensus Scoring System for diagnosis of periprosthetic joint infection in revision shoulder arthroplasty

BackgroundTotal shoulder arthroplasty (TSA) continues to undergo dramatic growth with expanding indications and improvements in implants and surgical techniques. A major complication following TSA is periprosthetic joint infection (PJI), which remains difficult to diagnose, often relying on clinical judgment. A contemporary definition of PJI was established at the 2018 International Consensus Meeting (ICM) on Musculoskeletal Infection. We sought to retrospectively examine the accuracy of this scoring system in previously performed revision TSA and hypothesized that the ICM scoring system would be reliable in determining the presence of TSA PJI. MethodsOur institutional database was reviewed to identify patients undergoing revision TSA before the advent of the ICM PJI scoring system. Clinical notes and operative reports were reviewed for data regarding the preoperative clinical examination, laboratory values, and intraoperative findings. The findings were assigned scores based on the definition of probable PJI by the ICM scoring system. Scores were compared to treatment plans of infected vs. noninfected patients. The diagnosis of PJI was made using a combination of clinical examination, laboratory values, and intraoperative findings. Sensitivity, specificity, positive and negative predictive values, and accuracy of the ICM scoring system were calculated compared to actual treatment decision, the gold standard. ResultsOf 81 revision arthroplasties, 52 were revision reverse TSA (rTSA), and 29 were revision anatomic TSA (aTSA). Seven rTSA patients were treated as infected (7/52, 13.5%), and the scoring system identified 4 of those as being probable infections (4/7, 57.1%). One additional rTSA patient scored as probable infection, underwent a revision for instability, and was found to have no infection. Three aTSA patients were treated as infected (3/29, 10.3%), with one of those identified as probable infection by the scoring system (1/3, 33.3%). Four patients in the rTSA group and no patients in the aTSA group met the criteria for definite infection. Using the threshold of probable infection to identify PJI, the sensitivity of the scoring system was 0.6, and specificity was 0.99. The positive predictive value was 0.86, and the negative predictive value was 0.95. With the same threshold, the ICM scoring system was 93.8% accurate. ConclusionsIdentifying PJI in TSA remains difficult in the absence of definite signs of joint sepsis. This study found the scoring system to be highly accurate, although with modest sensitivity, and a reliable tool for the diagnosis of PJI following TSA. Level of evidenceLevel IV; Retrospective Case Series with No Comparison Group Treatment Study

Parotid masses: The effectiveness of preoperative diagnostic methods on definitive diagnosis

Objective: 85% of neoplasms originating from the major salivary glands are seen in the parotid gland. The diagnosis of parotid masses can sometimes be made with a simple anamnesis and physical examination. However, despite all advanced examinations and biopsies, the preliminary diagnosis can be very different from the postoperative pathological diagnosis due to the unique embryological and anatomical features of the parotid gland. In our study, we aimed to evaluate the relationship between the accuracy of diagnostic tools and postoperative pathological diagnoses in patients who underwent parotidectomy. Materials and Methods: The files of patients who underwent surgery between 2014 and 2019 due to a parotid mass were evaluated. Preoperative neck ultrasound, computed tomography, magnetic resonance imaging, and fine-needle aspiration biopsies were evaluated. Postoperative pathological diagnoses and preoperative examination findings, imaging methods, and preliminary diagnoses obtained according to fine-needle aspiration biopsy results were compared and sensitivity, specificity, and accuracy rates were determined. Results: According to the postoperative pathologic diagnosis, 31 of the tumors were reported as benign (91.1%) and 3 as malignant (8.8%). Ultrasound defined 10 of 17 patients with benign pathology as benign (58.8%) and 7 as nondiagnostic (41.1%). Magnetic resonance imaging reported 11 of 15 benign cases as benign (73.3%), and defined 1 malignant case as nondiagnostic. It was observed that 20 of the patients who underwent fine-needle aspiration biopsy were reported as benign and 4 as nondiagnostic. Postoperative pathology results of 2 of 24 patients were reported as malignant, and 22 of them as benign. Conclusion: Although magnetic resonance imaging gives the most accurate information among the imaging methods evaluated for preoperative parotid masses, it cannot always make a definitive diagnosis. Although fine-needle aspiration biopsy is useful in distinguishing between malignant and benign tumors, malignant tumors can be reported as benign.

Salvaging the 'irreparable' tear: Superior Capsular Reconstruction augmented with partial cuff repair.

Massive rotator cuff tears (MRCTs) have long posed a complex problem for both patients and surgeons. If not treated promptly, tendon retraction, fatty infiltration and muscle atrophy of the rotator cuff muscles occur. These lead to irreparable RCTs with poor functional outcomes. We describe our technique of superior capsular reconstruction (SCR) augmented with partial cuff repair and report on our short term outcomes. Seven consecutive patients who underwent the procedure were recruited at our institution from January 2019 to December 2019. Medical records of these patients were reviewed looking at pre-operative symptoms and examination findings, imaging studies, intra-operative findings, the surgical technique employed, post-operative progress in terms of pain, affected shoulder range of movement and outcome scores. All patients showed complete tears of at least two tendons and were deemed irreparable intra-operatively. All patients exhibited Goutalier grade 2-4 wasting of the affected tendons on MRI and Patte grade 3 intra-operatively. At 12 months, the mean improvement shown in Constant score is 12.1 points, in University of California Los Angeles (UCLA) score is 9.4 points and in Oxford Shoulder Score is 17 points. Active forward flexion improved in all patients with a mean improvement of 40 degrees. Numerical Pain Rating Scale improved in all patients with a mean of 5.1 points. Our case series shows good short-term outcomes can be achieved with SCR augmented with partial cuff repair. Notably, our SCR results showed encouraging results even for challenging revision rotator cuff repairs.