Primary Goal Of Treatment Research Articles

Hypertriglyceridemia induced recurrent pancreatitis case

ABSTRACT: Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP). It is caused by disorders in lipoprotein metabolism due to primary or secondary causes. Metabolic syndrome is also an important factor contributing to the development of HTG. The primary treatment goal in severe HTG is to restore triglyceride levels within normal ranges which can be achieved with lipid lowering drugs mainly fenofibrates, fluid replacement, intravenous insulin infusion and/ or plasmapheresis treatments. Strict diet restricted from fat and simple sugars, exercise and weight control also contribute to HTG control in long term follow up. In this report, a case of severe AP triggered by HTG with other metabolic syndrome components like type 2 diabetes mellitus and obesity is presented.

Renin-angiotensin system blockade in patients with chronic kidney disease: benefits, problems in everyday clinical use, and open questions for advanced renal dysfunction.

Management of hypertension and albuminuria are considered among the primary goals of treatment to slow the progression of chronic kidney disease (CKD). Renin-angiotensin system (RAS) blockers, i.e., angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are the main drugs to achieve these goals. Seminal studies have showed that RAS blockers present significant renoprotective effects in CKD patients with very high albuminuria. In post hoc analyses of such trials, these renoprotective effects appeared more robust in patients with more advanced CKD. However, randomized trials specifically addressing whether RAS blockers should be initiated or maintained in patients with advanced CKD are scarce and do not include subjects with normoalbuminuria, thus, many clinicians are unconvinced for the beneficial effects of RAS blockade in these patients. Further, the fear of hyperkalemia or acute renal decline is another factor due to which RAS blockers are usually underprescribed and are easily discontinued in patients with more advanced CKD; i.e., those in Stages 4 and 5. This review summarizes evidence from the literature regarding the use of RAS blockers in patients with advanced CKD.

Management of ST Elevation Myocardial Infarction (STEMI) in Different Settings.

ST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that requires emergent, complex, well-coordinated treatment. Although the primary goal of treatment is simple to describe-reperfusion as quickly as possible-the management process is complicated and is affected by multiple factors including location, patient, and practitioner characteristics. Hence, this narrative review will discuss the recommended management and treatment strategies of STEMI in the circumstances.

Osteotomies around the thumb base in CMC 1 arthritis

The trapeziometacarpal joint (TMC) is a saddle joint that is subjected to tremendous repetitive loads through our lifetime. This joint is apparently congruent, but only a small part of the articular surface is loaded during pinch grips. This design implies a perfect bony anatomy, high quality articular cartilage and no ligament laxity. Under certain circumstances, where these different anatomical variables are imperfect, symptoms and pain can start at a very early stage in life. They are mainly acquired, but can be posttraumatic in origin. High quality radiographic views are needed: these radiographs must be done methodically by well-trained radiologists. The symptoms and radiographic changes may not match, such as when radiographic changes are minimal but functional impairment is significant. The primary goal of treatment is conservative. This cannot be stressed enough since conservative treatment can be successful with good follow-up by the hand surgeon: resting splint, good postures at work and if necessary, anti-inflammatory drugs and paracetamol. If this fails after a minimum of 6 months, different osteotomies can be proposed, combined with ligament augmentation in some cases. These osteotomies are mainly extra-articular, can be at the level of the base of the first metacarpal and the trapezium, or can be solely at the base of the first metacarpal. Isolated osteotomies of the trapezium should be avoided since they tend to close the first web space. In certain posttraumatic cases, intra-articular osteotomy of the malunion can be done to restore congruency and provide pain relief.

Effectiveness of TENS and home exercises as an adjunct to drug therapy in the management of myogenous masticatory pain: a comparative study

Introduction: Pain relief is the primary goal of treatment in patients with myogenous temporomandibular disorder. This study evaluated the effectiveness of TENS and Home exercises as an adjunct to drugs in relieving myogenous masticatory pain. Materials and methods: This prospective clinical study was conducted on 60 patients with myogenous masticatory pain. Patients were randomly allocated into three groups of 20 patients each. Patients in Group A received TENS and drugs, while patients in Group B received home exercises and drugs and Group C received drugs only. The drugs prescribed were Diclofenac 50 mg and Orphenadrine 100 mg, to be taken twice daily for 5 days. All patients were followed up for three weeks. The severity of pain was recorded using the Visual Analog Scale. Inter and intragroup differences in the pain scores were analyzed using one-way ANOVA along with post hoc Tukey's test, and Paired t-test, respectively. p < 0.05 was considered as statistically significant. Results: There was a significant reduction in the mean pain scores in all the three groups at 1st, 2nd, and 3rd post-treatment weeks as compared to the baseline scores with p < 0.001. However, when the pain scores were compared across groups, maximum pain reduction was observed in group A (0.2 ± 0.04), followed by group B (0.5 ± 0.06), and the least reduction was noticed in group C (2.1 ± 0.8). This result was significant with p < 0.001. Conclusion: Both TENS and Home exercises program were effective as adjuncts to drugs, in controlling myogenous masticatory pain, as compared to drugs alone.

Foot Macrodactyly with Simple Syndactyly: A Case Report from Northern Tanzania

We report a case report of a 5years old girl who presented with progressive enlarged and fusion of the second and third toes of the right foot since birth which impairs shoe wear. After a clinical history and examination and radiological evaluation, the diagnosis of right foot macrodactyly was established. Following surgical excision of the macrodactyly patient showed good clinical outcome after 1year of follow-up. Numerous treatment options have been suggested without consensus, specific treatment is individualized. The primary goal for treatment is a pain-free and functional foot that can accommodate normal shoes.

Vascular Calcification in Chronic Kidney Disease: Distinct Features of Pathogenesis and Clinical Implication.

Chronic kidney disease (CKD) is associated with a higher prevalence of vascular calcification (VC) and cardiovascular disease. VC in CKD patients showed different pathophysiological features from those of the general population. The pathogenesis of VC in CKD is a highly organized process, and prior studies have suggested that patients with CKD have their own specific contributors to the phenotypic change of vascular smooth muscle cells (VSMCs), including uremic toxins, CKD-mineral and bone disease (CKD-MBD), inflammation, and oxidative stress. For the diagnosis and monitoring of VC in CKD, several imaging modalities, including plain radiography, ultrasound, and computed tomography have been utilized. VC in CKD patients has distinct clinical features and implications. CKD patients revealed a more intense and more prevalent calcification on the intimal and medial layers, whereas intimal calcification is predominantly observed in the general population. While a higher VC score is clearly associated with a higher risk of all-cause mortality and cardiovascular events, a greater VC score in CKD patients does not fully reflect the burden of atherosclerosis, because they have more calcification at equal volumes of atheromatous plaques. The primary goal of VC treatment in CKD is the prevention of VC progression, and the main management is to control the biochemical components of CKD-MBD. Cinacalcet and non-calcium-containing phosphate binders are the mainstay of VC prevention in CKD-MBD management. VC in patients with CKD is an ongoing area of research and is expected to advance soon.

Simplified abductor pollicis longus suspension interposition arthroplasty for thumb carpometacarpal joint osteoarthritis

PurposeThe primary treatment goals for advanced-stage thumb carpometacarpal (CMC) joint osteoarthritis are complete pain relief and restoration of thumb strength. The purpose of the present study was to introduce a variation of the abductor pollicis longus (APL) suspension arthroplasty using a single looping of a radial slip from the APL tendon around the flexor carpi radialis (FCR) tendon combined with RegJoint™ interposition and to determine its efficacy in the treatment of thumb CMC joint osteoarthritis.MethodsBetween 2015 and 2017, 21 patients were included. The average age was 60.8 years (range 48–79). The mean follow-up was 27.7 months (range 8–50). Evaluation included pain, radial and palmar abduction, tip pinch and grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsPain averaged 0.3 (range 0–4) at rest and 1.4 (range 0–4) on exertion. The radial and palmar abduction were 97% and 99% compared to the contralateral side. The tip pinch and grip strength were 4.1 kg (range 3–6.5) and 22 kg (range 13.3–40), respectively. The DASH score accounted for 18.5 (range 0.8–41.7).ConclusionThe modified APL suspension interposition arthroplasty was an efficient and simplified option for the treatment of thumb CMC joint osteoarthritis, with results comparable or better than other published procedures. The APL suspension technique was easy to perform avoiding difficult bone tunneling and incision of the FCR tendon. The RegJoint™ interposition as spacer prevented impingement of the first metacarpal base on the second metacarpal base or the trapezoid bone.

Emergency care for life-threatening arrhythmias

Background. Sepsis is often accompanied by arrhythmias and conduction disorders. It can be assumed that pacemaker cells of the sinoatrial node, strongly sensitized by massive stimulation with β1-adrenergic catecholamines, tend to trigger arrhythmias. The importance of the inflammatory component in the development of new atrial fibrillation (AF) events is also confirmed by the existence of a strong correlation between increased levels of C-reactive protein, interleukin-6 and tumor necrosis factor and the onset of fibrillation. Under the conditions of the new-onset AF, the hospital mortality of patients of general profile in the intensive care unit (ICU) significantly exceeds that for people without AF.
 Objective. To describe the features of treatment of life-threatening arrhythmias.
 Materials and methods. Analysis of literature data on this issue.
 Results and discussion. Amiodarone, diltiazem and lidocaine are the most commonly used treatments for life-threatening arrhythmias. According to a UK-wide study, amiodarone is used to treat new-onset AF in ICU in 80.94 % of cases, β-blockers (BB) – in 11.60 %, other antiarrhythmic drugs (AAD) – in 3.87 %, and digoxin – in 3.31 %. However, this tactic is not in line with the existing guidelines. According to the recommendations for the heart rate (HR) control in emergency care for AF (Bokeria L.A. et al., 2017), in an acute situation in the absence of ventricular pre-excitation syndrome intravenous administration of BB or non-dihydropyridine calcium channel blockers (CCB) is recommended to slow ventricular rhythm in patients with AF. Caution should be taken in patients with hypotension or heart failure. For the last group of patients intravenous administration of cardiac glycosides or amiodarone is recommended. In patients with ventricular pre-excitation syndrome, class I AAD or amiodarone are the drugs of choice. In presence of the pre-excitation syndrome and AF BB, non-dihydropyridine CCB, digoxin and adenosine are contraindicated. The guidelines for the management of AF patients, developed in 2017 by the European Society of Cardiology in collaboration with the European Association of Cardiothoracic Surgery, recommend to use different management tactics depending on the left ventricular ejection fraction (LV EF). In case of LV EF <40 % or signs of heart failure, the lowest effective dose of BB should be prescribed to achieve rhythm control. Amiodarone is prescribed to hemodynamically unstable patients or to individuals with severely reduced LV EF. The primary goal of treatment is to achieve a HR <110 beats/min. In the absence of this result, digoxin should be added. In case of LV EF ≥40 %, BB, or diltiazem, or verapamil should be administered. In the absence of clinical result, digoxin should be added. Practical models of AF treatment in sepsis have demonstrated the superiority of BB over CCB, digoxin and amiodarone (Walkey A.J. et al., 2016). BB weaken the stimulating effect of the sympathetic part of the autonomic nervous system on the myocardium, have a negative chronotropic effect, improve the contractility of ischemized cardiomyocytes, slow atrioventricular conduction, reduce myocardial oxygen demand, and apoptosis. Esmolol (Biblok, “Yuria-Pharm”) is indicated for supraventricular tachycardia (except for ventricular pre-excitation syndrome) and for the rapid control of ventricular rhythm in patients with AF or atrial flutter in the pre- and postoperative periods or in other circumstances when it is necessary to normalize ventricular rhythm with a short-acting drug. Studies show that esmolol inhibits inflammation in sepsis by increasing the expression of the antimicrobial peptide cathelicidin. Kaplan – Mayer analysis shows better survival for experimental animals with sepsis receiving esmolol compared to animals in the 0.9 % NaCl group (Ibrahim-Zada I. et al., 2014).
 Conclusions. 1. Sepsis is often accompanied by arrhythmias and conduction disorders. 2. Under the conditions of new-onset AF, the hospital mortality of patients of general somatic profile in ICU significantly exceeds the number for people without AF. 3. In case of AF and LV EF <40 % or signs of heart failure, the lowest effective dose of BB should be prescribed to achieve rhythm control. 4. In case of LV EF ≥40 %, BB, or diltiazem, or verapamil should be administered. 5. Esmolol is indicated for supraventricular tachycardia and for the rapid control of ventricular rhythm in patients with AF or atrial flutter. 6. Esmolol inhibits inflammation in sepsis by increasing the expression of the antimicrobial peptide cathelicidin.

Arterial hypertension: the accent on the target organs’ protection

Background. Prolonged untreated arterial hypertension (AH) is accompanied by the damage of target organs (brain, eyes, kidneys, heart and large vessels). This problem can be prevented by the stable control of blood pressure (BP).
 Objective. To identify the main strategies for the target organs protection in AH.
 Materials and methods. Analysis of the available guidelines and literature data; the own study of L-arginine (Tivortin, “Yuria-Pharm”) administration.
 Results and discussion. BP lowering is an integral part of improving the outcome in patients with AH. Reduction of systolic BP by 10 mm Hg leads to the reduction of stroke risk by 27 %, heart failure risk – by 28 %, coronary heart disease risk – by 17 %. The primary goal of treatment of all patients with AH is to achieve the BP level <140/90 mm Hg, in case of good tolerability – <130/80 mm Hg. More intensive treatment with the achievement of BP <130/80 mm Hg provides a more pronounced reduction of the risk of cardiovascular events. Reduction of systolic BP <120 mm Hg is not reasonable. In patients with AH and chronic kidney disease, the target systolic BP should be 130-140 mm Hg. It is important to achieve normalization of BP quickly (within 3 months of treatment), as an early control of this parameter provides a better prognosis (VALUE study). The treatment strategy for uncomplicated AH involves initial therapy with a two-component combination in a single tablet (angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) + calcium channel blocker (CCB) or diuretic). At the next stage, a triple combination (ACEI/ARB + CCB + diuretic) is prescribed. According to the indications, β-blockers can be added at any stage. It is necessary to use drugs with proven organoprotective properties based on the target organs affection and concomitant nosological conditions of each individual patient. Even in patients with resistant AH long-term antihypertensive therapy improves renal function and reduces left ventricular hypertrophy. Additional ways of organoprotection in hypertension include the influence on the vascular endothelium condition. According to the results of our own study, the inclusion of L-arginine (Tivortin, “Yuria-Pharm”) into the basic therapy of AH can significantly reduce albuminuria compared with the control group (basic therapy without L-arginine), as well as improve the flow-dependent vasodilation (from 6.7 to 13.6 %, whereas in the control group this parameter has changed from 6.5 to 9.8 %; p<0.001). In the L-arginine group, the glomerular filtration rate also increased significantly, while in the control group this indicator decreased. The renal artery resistance index also decreased (from 0.68 to 0.65 units; no changes were recorded in the control group).
 Conclusions. 1. To prevent the damage of target organs, it is necessary to quickly and stably reduce BP to the target values. 2. It is advisable to prescribe antihypertensive drugs with proven organoprotective properties. 3. L-arginine (Tivortin) improves the condition of the endothelium, thereby promoting vasodilation and improving renal function.

Current and Future Perspectives of the Use of Organoids in Radiobiology.

The majority of cancer patients will be treated with radiotherapy, either alone or together with chemotherapy and/or surgery. Optimising the balance between tumour control and the probability of normal tissue side effects is the primary goal of radiation treatment. Therefore, it is imperative to understand the effects that irradiation will have on both normal and cancer tissue. The more classical lab models of immortal cell lines and in vivo animal models have been fundamental to radiobiological studies to date. However, each of these comes with their own limitations and new complementary models are required to fill the gaps left by these traditional models. In this review, we discuss how organoids, three-dimensional tissue-resembling structures derived from tissue-resident, embryonic or induced pluripotent stem cells, overcome the limitations of these models and thus have a growing importance in the field of radiation biology research. The roles of organoids in understanding radiation-induced tissue responses and in moving towards precision medicine are examined. Finally, the limitations of organoids in radiobiology and the steps being made to overcome these limitations are considered.

PCN272 Treatment of Advanced Renal Cell Carcinoma in Spain: Oncologists’ Preferences

Several systemic therapy options are available for advanced renal cell carcinoma (aRCC) and physicians assess the appropriate regimen for each patient based on treatment characteristics. The aim of the study is to determine oncologists' preferences for the characteristics of aRCC treatment in Spain. Observational study based on a discrete choice experiment (DCE), developed in four phases: 1) setting up a scientific committee to lead the project; 2) literature review to identify treatment characteristics; 3) focus groups (5 patients, 8 oncologists) to prioritize characteristics; 4) survey development. Five treatment attributes, with three levels each, were included in the DCE: survival gain (6months, 1.5years, 3years), severe adverse effects (SAEs) (5%, 15%, 30%), health-related quality of life (HRQoL) (worse, maintained, improved), administration mode (oral 1-2/day, intravenous monthly, intravenous every 15 days) and monthly cost (€3000, €5000, €8000). Data were analyzed using a mixed logit model. Relative importance (RI) of attributes was calculated. Additionally, willingness to pay for the treatment (cost assumed by the health system) and maximum acceptable risk (MAR) of SAEs in exchange for clinical efficacy were estimated from the DCE. Sixty-seven oncologists participated in the study (52.2% men, mean age 41.9 years [standard deviation: 8.4]). All attributes/levels were significant (p<0.05), except for monthly intravenous administration and HRQoL maintenance. The highest RI was attributed to survival gain (54.7%), followed by HRQoL (18.0%), administration mode (11.1%), SAEs (10.8%), and treatment cost (5.5%). Higher cost would be accepted for extending survival by 1 month than for reducing SAEs risk by 1%. The MAR in exchange for extending survival by 1 month was 4.2%. From the oncologist’s perspective, survival gain is the primary goal of aRCC treatment. HRQoL, administration mode and SAEs are also important attributes to consider for decision-making, while treatment cost has low impact on treatment election.

Occurrence and Management of Empyema Thoracis During Covid-19 Times

Introduction: Empyema is defined as an infected pleural fluid collection, evidenced either by purulent fluid or the presence of bacterial organisms. The aim of this study is to highlight the importance of early diagnosis and management of empyema in an attempt to avoid needless procedures and dreaded complications while shining a light into the warrant of a multidisciplinary approach that would had a paramount significance during the lockdown period in Greece, between March-June of 2020 due to COVID-19, in ameliorating those issues. Patients and Methods: During the aforementioned period 12 patients were treated at our Department, 11 of them were male, ages ranging from 22-71 years old. The cause of empyema was parapneumonic effusion from a bacterial pneumonia in 10 patients and the other 2 were tuberculous empyema and extension of an intraabdominal process (Diffuse large B-cell lymphoma of the stomach). Predominately the patients were admitted to our Department with stage III empyema. Diagnosis was confirmed with CT scan and drainage of frank pus from the chest tube. All patients underwent chest tube insertion and antibiotic therapy nonetheless 9 of them required surgical management with VATS or open decortication. Results and Conclusion: The impedance in seeking medical advice due to fear of COVID-19 and the insufficiency of an interdisciplinary approach in the management of those patients were determined as the reason for such high admittance with stage III empyema. The decision of open vs VATS decortication was made based on the medical status and history of each individual, the stage of the empyema and ultimately our ability to achieve the two primary goals of empyema treatment, complete evacuation, and lung reexpansion [1]. Eight patients underwent open decortication and drainage and one managed with VATS decortication. Postoperative complications were encountered in 3 patients which included prolonged air leak, surgical wound infection, and septic shock. One patient died from multiple organ failure due to postoperative septic shock. The duration of chest tube drainage varied from 5-15 days. The mean hospital stay was 13,5 days.

Single 225μg/Kg Dose Treatment with Eptacog Beta (Factor VIIa, Recombinant) Results in Rapid Hemostasis in Joint Bleeds for Persons with Hemophilia Α or Β with Inhibitors: A PERSEPT1 Subset Analysis

Single 225μg/Kg Dose Treatment with Eptacog Beta (Factor VIIa, Recombinant) Results in Rapid Hemostasis in Joint Bleeds for Persons with Hemophilia Α or Β with Inhibitors: A PERSEPT1 Subset Analysis

KAP Survey on Endodontic Irrigants and Its Deleterious Effects

The aim is to assess how aware the dental students are about endodontic irrigants and the deleterious effect. Successful root canal therapy relies on the combination of proper instrumentation, irrigation, and obturation of the root canal. Of these three essential steps of root canal therapy, irrigation protocol is very important as it determines the healing of the periapical tissues. The primary endodontic treatment goal must thus be to optimize root canal disinfection and to prevent reinfection. Cytotoxicity of root canal irrigants is essential due to their close contact with host tissues. The study aimed to assess how aware the dental students are about the deleterious effects of endodontic irrigants. A cross-sectional study was conducted among dental students in January 2020. The survey was made on the app survey planet and a questionnaire was administered to 100 dental students about their awareness of cytotoxicity of irrigants in endodontics. The data was collected and put into bar charts in SPSS version 20 by IBM for statistical results. It is observed 38% were interns, 33% were final years and 29% were third years. 90% were aware of what irrigants are, 86% were aware of the types of irrigants, 76% were aware of the cytotoxicity of irrigants, 49% used sodium hypochlorite, 21% used chlorhexidine, 10% used MTAD, 8% used citric acid and 12% have used all of the above. 65% are aware of the duration of irrigants in canals. 59% think irrigants can be used in a previously treated tooth, 20% disagree and 21% are not sure. A p-value of 0.000 was obtained which is statistically significant as p&lt;0.05. In vitro cytotoxicity tests are usually carried out for new materials before applying them clinically. These irrigating solutions should be used at lower concentrations to enhance cell viability and protect the tissues from toxicity damage, irrespective of their increased efficacy at higher concentrations. Through this study, it was evident that students are not fully aware of the deleterious effects of endodontic irrigants though they are used daily. The awareness of the concentration and type of irrigant to be used should be more emphasized during theory classes so that the same can be followed during clinical procedures.

Rehabilitation After Shoulder Instability Surgery: Keys for Optimizing Recovery.

The specific approach to rehabilitation after surgical management of the unstable shoulder is dependent on the severity and chronicity of the instability. Establishing dynamic stability throughout the athlete's functional range of movement is critical to a successful outcome. The pace progression is guided by surgical (technique, injury pattern, and strength of repair) and patient factors (healing potential, prior health status, and psychosocial factors). The primary goal of treatment is to restore function and return the athlete to sport. The process should be guided by surpassing functional criteria for progression and tissue healing time.

Multichannel lung sound analysis to detect severity of lung disease in cystic fibrosis

ObjectiveRespiratory disease in Cystic fibrosis (CF) patients is one of the main causes of the reduction in pulmonary function and death. The primary goals of CF treatment include maintaining or improving pulmonary function and reducing the rate of pulmonary function decline. Therefore, the severity of lung disease should be monitored in CF patients. The objective of this study is to examine multichannel lung sound analysis in detecting the severity of lung disease in CF patients. Methods209 multichannel lung sound samples were recorded from thirty seven CF patients using a thirty channel acquisition system. Then, expiration to inspiration lung sound power ratio features in different frequency bands (E/I F) were extracted from large airway, upper airway and peripheral airway channels. These features were compared between the groups with different severity levels of the lung disease using Support Vector Machine, Artificial Neural Network, Decision tree and Naïve Baysian classifiers by ‘leave-one-sample-out’ method. ResultsIt was shown that features of upper airways and peripheral airways were more effective in discriminating normal from mild (91.1%) and moderate from severe (92.8%) respiratory sound samples, respectively. The best result for discriminating between all groups of severity was related to neural network classifier which performs 89.05% average accuracy. Also, ‘leave-one-subject-out’ method confirmed the results. ConclusionThe proposed multichannel lung sound analysis method was successful in discriminating different severity levels of CF lung disease. Moreover, analysis of different lung region signals in consecutive levels of lung disease was consistent with regional damage of lung in CF.

Value of Intraoperative Ultrasound in Decreasing Incidence of Residual Radiolucent Stones Post- Percutaneous Nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large renal calculi. The primary goal of treatment is absolute clearance of stone. The incidence of residual stones after PCNL ranges from 10% to 60% and may be higher in radiolucent stones. Aim of work: Our objective was to assess the effectiveness of the use of ultrasound during PCNL in patients with radiolucent stones in reducing the incidence of residual fragments postoperatively. Patients and Methods: This was a single center prospective study over a 6 year period. We identified 86 patients undergoing PCNL with radiolucent stones. Ultrasound was used in conjunction with traditional fluoroscopy to identify residual fragments. Each patient had a first day post-operative computed tomography to assess for residual fragments. The sensitivity of ultrasound with fluoroscopy was compared to clinically or radiologically [CT] detected residual fragments. Results: Our overall stone clearance rate was 82.6% [as evidenced by postoperative CT]. The sensitivity of intra-operative ultrasound when compared to postoperative CT was 95.8%, specificity 40.0%, the positive predictive value 88.3% and negative predictive value 66.7%Conclusions: The use of intra-operative ultrasound during PCNL for radiolucent stones may help in reduction of postoperative imaging. However, future studies are recommend.

Clinical decision model for the reconstruction of 175 cases of scalp avulsion/defect.

It has been reported widely on various methods of repairing scalp avulsion/defect, including anastomotic vessels for total scalp avulsion and dermal grafts (skin grafting, latissimus dorsi or anterior serratus flap, "visor flap" repair.). The long-term retrospective study, however, with large sample size remains rare; and there is no report on decision-making tree for repairing emergency scalp avulsion/defects under critical conditions. The decision-making model is provided for surgeons to design the scalp reconstruction based on the retrospective analysis of 175 cases of scalp avulsion/scalp defect. In this 10-year retrospective study, 175 cases of the repair of scalp avulsion and scalp defects in a single center were analyzed. The clinical decision model was generated based on representative cases. For patients with scalp avulsion/defects, a comprehensive examination and evaluation on systemic injury and complication should be conducted first for saving lives and reducing trauma effects. To make more reasonable clinical decisions, it is also required to determine the location, size, depth of scalp defect the injury area of cranial periosteum, injury of blood vessel or other adjacent organs, and whether the scalp can be reused. Meanwhile, it is necessary to evaluate whether the patient can tolerate long-term anastomotic vascular surgery according to the vital signs and physical status. The primary treatment goal is to decrease traumatic effects and save patient's life while repairing and reconstructing scalp avulsions and scalp defects. In addition, it is necessary to comprehensively consider the anatomical, functional and cosmetic characteristics of scalp, surgical equipment, team technical skillsets and patient's own pursuit to optimize a reasonable surgical solution.

Short term results following hip arthroplasty (total/hemi) in elderly patients with femoral neck fracture in a tertiary care hospital

Background: Intracapsular fractures of the neck of femur are a major cause of morbidity and mortality in elderly population in India. The primary goal of treatment in these patients is to get the patients to the preinjury level of functionality as early as possible and with minimal complications. Multiple modes of operative treatment in the form of fixation devices (screws, plates, nails) and replacement (hemi or total replacement) are available for this fracture. However, a high rate of complications and revision surgeries has been found after internal fixation in this population group owing to the unique challenges to fixation in the form of co morbidities and osteoporosis among others. Instead of internal fixation, replacement is thus a viable option.Materials and Methods: 100 patients (age >65 years) with a femoral neck fracture were treated over a two-year period (May 2018 to April 2020) with some form of hip replacement after appropriate anesthetic fitness. Results: We had good results in majority of the patients in terms of return to pre-fracture level of functionality, independent ambulation and satisfaction with the results. A majority of patients treated with hemiarthroplasty recovered without incidence while all patients of total hip replacement progressed without incidence. There were 10 cases of suture line infection which recovered satisfactorily with a change of antibiotics, 4 cases of deep infection for which debridement and implant removal was required, 3 cases of deep vein thrombosis and 7 cases of dislocation. Conclusion: Hip replacement is a viable option for treatment of femoral neck fractures in patients more than 65 years of age. Return to preinjury level of functionality is pretty satisfying and early if the patient is actively mobilized as early as possible postoperatively. There are no risks of nonunion, malunion and implant related complications as compared to internal fixation devices.