Single-stage Procedure Research Articles

Forecasting carbon dioxide emissions: application of a novel two-stage procedure based on machine learning models

Abstract Accurate forecast of carbon dioxide (CO2) emissions plays a significant role in China's carbon peaking and carbon neutrality policies. A novel two-stage forecast procedure based on support vector regression (SVR), random forest (RF), ridge regression (Ridge), and artificial neural network (ANN) is proposed and evaluated by comparing it with the single-stage forecast procedure. Nine independent variables’ data (study period: 1985–2020) are used to forecast the CO2 emissions in China. Our results reveal that, when the time gap, h increases from 1 to 8, the average root mean squared error (RMSE) and mean absolute error (MAE) of SVR–SVR, SVR–RF, SVR–Ridge, and SVR–ANN are almost uniformly lower than errors arising from their single-stage version, respectively. Among these two-stage models, SVR–ANN exhibits the lowest forecast errors, whereas SVR–RF admits the highest. The mean percentage decrease in forecast errors of SVR–SVR vs. SVR, SVR–RF vs. RF, SVR–Ridge vs. Ridge, and SVR–ANN vs. ANN are 36.06, 5.98, 43.05, and 14.81 for RMSE, and 36.06, 6.91, 43.27, and 15.35 for MAE. Our two-stage procedure is also suitable to forecast other variables, such as fossil fuel and renewable energy consumption.

Electrokinetic Properties of Mesoporous Vitreous Membranes Doped by Silver-Silver Halides

Silver/silver halide materials are considered as efficient and highly stable plasmonic photocatalysts for the organic pollutant degradation and hydrogen evolution from water splitting under solar irradiation, and they possess promising antibacterial activity. Ordered mesoporous silica materials including porous glasses are considered as the most promising template for silver-containing structures. In the present work, Ag/AgHal-doped (Hal = Cl, Br) vitreous membranes on a base of the mesoporous glasses were prepared via step-by-step single-stage impregnation procedure. The chemical and phase composition of the modified membranes were identified by the X-ray photoelectron spectroscopy, the X-ray diffraction and the energy-dispersive X-ray spectroscopy. The structure and morphology of inner membrane space were studied by the scanning electron microscopy. Electrokinetic properties of the silver-containing vitreous membranes were determined by the differential method and the streaming potential method. The inner membrane space is modified unevenly with appearance of the clearly defined regions with different silver content. The formation of the Ag/AgCl clusters along with the individual nanoparticles over thickness of the 1-mm membrane with mean pore radius of 23 nm was detected. The modification of the pore space by Ag-containing structures and the type of halogen ion almost do not affect the electrochemical behavior of the mesoporous vitreous membranes.

True "outpatient discharge" following single-stage bilateral unicompartmental knee arthroplasty may be unrealistic for most.

Single-stage bilateral unicompartmental knee arthroplasty (BUKA) has shown post-operative function and cost benefits over staged bilateral procedures, without increased complications. A rapid discharge protocol at the current study site has reported outpatient discharge for the unilateral procedure exceeding 97%. However, the feasibility of outpatient discharge following BUKA remains unclear. Therefore, the purpose of this study was to determine the success of achieving outpatient (< 24h) discharge following BUKA, and identify patient variables associated with failure. A retrospective chart review was completed for 104 BUKA patients. All patients with bilateral, symptomatic unicompartmental knee arthritis were offered the single-stage procedure. Data collection included patient demographics, discharge status, and disposition location. Independent t tests (continuous) and Chi-squared tests (categorical) determined differences between discharge (outpatient/inpatient) and disposition (home/other) groups. Variables associated with discharge status and location were assessed with multivariable regression. While 96 (92.3%) patients discharged within 24h, only 63.5% were able to discharge directly home. Patients requiring a longer hospital stay (> 24h) were more likely to require a pre-operative assistive device (62.5% and 25.0%, p = 0.037) and live alone (37.5 vs 8.3%, p = 0.033). For those discharged within 24h, living alone significantly increased the risk (odds ratio: 5.800, p = 0.038) of requiring an acute inpatient facility prior to transition home. Achieving "true" outpatient discharge is only modestly successful for most BUKA patients, as many required an acute inpatient or short-term rehabilitation facility prior to returning home. BUKA should be differentiated from the unilateral procedure regarding outpatient discharge expectations. III, Case-control study; Retrospective comparative study.

Neglected bilateral multi-ligament knee injury managed by single-stage limb reconstructive surgery: A very rare case report with literature review

Abstract A multi-ligament knee injury (MLKI) can be a devastating injury. A poorly managed, missed, or neglected injury presenting with a painful arthritic crippling unstable limb needs reconstructive surgery. We present a case report of bilateral MLKI presenting with late neglected knee dislocations (KD) in a 37-year-old male. A rotating hinge arthroplasty for a KD5 right knee MLKI and an arthroscopic reconstruction combined with an open repair of the KD3M left knee MLKI have been presented. The strategy for simultaneous reconstructive procedures has been detailed. The preoperative clinical assessment, imaging, anticipated per-operative technical challenges, and adapting a postoperative guided rehabilitation protocol were important considerations. The advantages of a single-stage MLKI management were multi-fold. The single-stage limb reconstructive surgery gave a good functional outcome. A comprehensive review of case reports and studies for chronic or neglected KD provides an update on the various treatment strategies. The bilateral affection allowed for the utilization of contralateral autografts for the reconstructive surgery of the other knee. The combined arthroplasty and ligament repair for two knees as a single-stage procedure allowed an immediate weight-bearing potential to a wheelchair-bound bedridden adult. The precise decision-making, sound reconstruction principles, and meticulous coordinated surgical skills gave a favorable clinical and functional outcome.

Successful Outcome in Posttraumatic Superficial Femoral Artery Pseudoaneurysm following Distal Femur Fracture

A 60-year-old woman sustained right femur fracture and presented to us after taking native massage therapy for 6 weeks. Radiographs showed suspected posteromedial soft tissue shadow. Further imaging confirmed a rare pseudoaneurysm of the superficial femoral artery. After vascular surgery consultation, a single-stage procedure was planned. Through medial approach to distal femur, Pseudo aneurysm was haemodynamically isolated, opened and its contents evacuated. Neck of pseudo aneurysm is located and ligated. Distal femur plating (broad DCP) was done through the same exposure. Since traumatic pseudoaneurysms are rare entities, surgeons should have a high degree of suspicion for preoperative identification. It facilitates simultaneous vascular repair and fracture fixation. It avoids two-stage incisions, two incisions, intraoperative or postoperative catastrophe, and medicolegal complications. Hence, we advocate to look out for vascular injury in distal femur fractures at a delayed presentation.

Flap Application in Reconstructive Surgery to Manage Severe Radiation-induced Ulcers: A Case Series

Introduction. Radiation-induced ulceration is a late-stage skin reaction after RT for cancer treatment. Objective. The present study examined the use of a single-stage reconstructive procedure to manage radiation-related wounds. Materials and Methods. Nine patients with radiation-induced chronic ulcer with accompanying severe complications were admitted to the Plastic, Reconstructive, and Regenerative Center of Viet Nam National Burn Hospital between October 2015 and September 2019. The patients ranged in age from 49 to 77 years. Complications included exposed cheekbone (n = 1), exposed trachea (n = 1), exposed carotid artery (n = 2), exposed axillary artery (n = 2), exposed pleura (n = 1), and exposed pericardium (n = 2). Flap type used to achieve defect coverage after debridement was individualized to each patient and included ALT, LD, SCA, and DIEP flaps. Additionally, a high-density polyethylene was used to reconstruct the trachea to recover breathing function in the patient with exposed trachea. Results. Complete survival of all flaps was achieved. Most vital organs (the trachea, axillary artery, and carotid artery) were covered. Hospital length of stay ranged from 15 to 120 days. Conclusions. The successful management of patients with severe complications suggests that immediate single-stage reconstruction may be a valuable option for managing radiation-induced ulcers.

A prospective observational study of functional outcome of fracture distal end of Tibia, treated with minimally invasive plating osteosynthesis (Mippo) technic

Background: Distal tibia fractures including Tibia pilon fractures present a challenge as to their best method of management due to subcutaneous location of larger portion of tibia, paucity of soft tissue coverage and precarious blood supply to the distal leg. The involvement of the ankle joint and the vulnerability of the surrounding soft tissues further complicate these already complex injuries. Numerous classifications have been proposed for these fractures, however AO-OTA alphanumeric classifications the most comprehensive as well as the most commonly quoted classification. The lower end of the tibia including its medial and the lateral malleoli of the fibula form a socket (mortise) into which the body of the talus articulates, and along with capsule and ligament thus form the ankle joint. Any disruption of length, axis or rotation of the fibula or the tibia can result in an incongruent ankle joint. The lateral aspect of the distal tibia forms a triangular notch where the fibula articulates. The interosseous membrane and the anterior and posterior tibiofibular ligaments bind these bones together.Aim: To evaluate the efficiency of internal fixation for the fractures of distal tibia by using minimally invasive plating osteosynthesis [Mippo] technique. To assess the functional outcome of Mippo technique with locking compression plate and dynamic compression plate.Methods: A prospective observational study of patients above the age of 20 years with distal tibia fracture admitted in King George hospital, Visakhapatnam. Study duration 9 months.Results: There were 72 patients in the study including 50 males (69.4%) and 22 females (30.6%) of mean age 46 years. The commonest cause of injury was RTA with High energy trauma with total of 31 patients (43.06%) followed by Low energy RTA with total of 28 patients (38.89%) and the rest 28 of the patients with Low energy fall (18.06%) respectively. All fractures united at an average of 15 weeks (range 12 to 20 weeks). As regards pain, 48 patients (66.66%) were pain-free, 18 patients (25%) had only occasional pain.Conclusion: It is well accepted that the final outcome of distal tibial fractures including pilon fractures with this MIPPO technique, a single stage operative procedure. It is obvious that these are not directly influenced by this technique MIPPO, single-stage operative procedure, contributing to a favorable outcome.

Oncoplastic Augmentation Mastopexy in Breast Conservation Therapy: Retrospective Study and Postoperative Complications.

Oncoplastic techniques, in conjunction with lumpectomy and adjuvant radiotherapy, have been demonstrated to achieve good aesthetic results and cancer outcomes in the treatment of patients with macromastia or significant ptosis. This study evaluated a series of patients undergoing breast conservation with concomitant oncoplastic-augmentation-mastopexy and a contralateral augmentation-mastopexy. Patients undergoing lumpectomy for breast conservation were identified via a retrospective chart review. Inclusion criteria included patients with ptosis and preexisting breast implants or insufficient breast volume undergoing oncoplastic implant placement/exchange and mastopexy. Demographic characteristics, operative details, and complications were assessed. Thirty-four consecutive patients (64 breasts, 4 unilateral procedures) were included in the study. Average age was 51.4 years, average body mass index was 27, and 38.2% were smokers/former smokers. The average operative time was 2.5 hours. Furthermore, 38.2% of patients received chemotherapy, and 82.4% of patients received breast adjuvant radiotherapy. The average length of follow-up was 11.7 months. In the sample that received radiation, the capsular contracture rate was 25%, with a 7.1% contracture revision rate. For the entire group, a total of 8 patients (23.5%) underwent revisions for either positive margins (8.8%), capsular contracture (8.8%), implant loss (2.9%), or cosmetic concerns (2.9%). One patient developed a pulmonary embolism. Oncoplastic-augmentation-mastopexy is a safe technique with acceptable complication rates. This technique is best used for breast cancer patients with breast ptosis and a paucity of breast volume or preexisting implants who wish to pursue breast-conserving therapy. The revision rates are acceptable compared with single-stage cosmetic augmentation procedures as well as other oncoplastic techniques described in the literature, but patients must be clearly counseled on contracture risk.

Wide-based oblique anastomosis reduces urethral stricture rate following the transverse preputial island flap procedure.

The transverse preputial island flap (TPIF) procedure remains one of the classic single-stage procedures for severe hypospadias repairs. The incidence of postoperative complications remained high. This study aims to describe a modified urethral anastomosis technique during the TPIF procedure for severe hypospadias repairs and report its outcomes. Data were collected retrospectively from consecutive patients who underwent the TPIF procedure by the same pediatric urologist between January 2018 and June 2023. Collected information included age at surgery, operative details, and outcomes at follow-up. Wide-based oblique anastomosis (WOA) technique was used as a modified urethral anastomosis in all cases. In brief, the dorsal edge of anastomosis was breadthwise anchored to the corpus cavernosum with 4-5 stitches, forming a spade-shaped anastomotic surface. A total of 72 patients were included in the study. The location of the corpus spongiosum division was penile in 27 patients (37.5%) and proximal in 45 patients (62.5%). The median glans width was 13 mm (range, 6-30 mm). The median ventral curvature after degloving was 45° (range, 30-150°). At a median follow-up of 4.1 years, complications occurred in 15 patients (20.8%), including nine cases of fistula, seven cases of urethral diverticulum and two cases of meatal stenosis. No cases of urethral stricture (US), urethral dehiscence, or ventral curvature occurred. Subsequent reoperations for diverticulum repairs showed that the dorsal side of the anastomosis was extensively fixed to the corpus cavernosum, forming a wide-based, spacious lumen. WOA technique is straightforward and effective, especially in the prevention of postoperative US.

Accordion maneuver with Ilizarov placed plate in situ, in a case of femoral shaft non-union and refracture with quiescent infection, discussion on treatment strategies: a case report

Introduction: Aim of this study to evaluate the clinical efficacy and highlight their relevance in present orthopedics practice where multiple newer choices have been become famous. Accordion maneuver design with modified Ilizarov apparatus, a single stage procedure in femoral shaft non-union and re-fracture with quiescent infection place dynamic compression plate (DCP) in situ. Femoral shaft fractures (FSFs) are frequently occurring injury due to RTA. Infection (0.4%) and non-union (1.1 - 14%) are the morbid complications of femur fractures. The healing rate for femora shaft non-unions is too high (90%).1 Accordion Maneuver (AM) is the “Bloodless Stimulation” of bone healing described by Professor G. A. Ilizarov. It comprises of alternate compression and distraction which produce stress in living tissue and also convert biologically inactive scar tissue at non-union site into tissue capable of neo-osteogenesis.2 The suggested treatment for quiescent type of infected non-union is a single stage procedure with minimal or no debridement and if implant is provide sufficient stability it placed in situ.3 Case Report: In the case, a 26 years man treated by DCP with MIPO for his Gustilo type – Ⅰ open, comminuted fracture of mid femoral shaft (Left) following RTA. Post-operative infection occurred within 2 weeks of operation. Infection controlled by exploration and surgical toileting with antibiotic. After four (4) months later he was sustained re-fractured with bending plate due to fall again. Finally he was diagnosed as H. Rosen`s type 3 Quiescent infected non-union (Oligotrophic) and Romano stage -1 post-implant infection with re-fracture mid shaft of left femur. Then he was treated following accordion principles with modified Ilizarov frame. AM was applied according to protocol of Baruah and Patowary of non-union treatment. Result: After complete union and consolidation, substantiated by radiological evidence Ilizarov apparatus was dispelled six (6) months later of installation without removal of plate and four (4) months of that finally plate was removed. After one (1) year and four (4) months of mounted Ilizarov frame, the patient was in full free movement of knee and hip. He had no problem during walking even running. Conclusion: We pursue for the treatment, accordion maneuver with Ilizarov apparatus, a single stage procedure in femoral shaft non-union and re-fracture with quiescent infection kept plate in situ. Few authors reported, Accordion Maneuver (AM) techniques with Ilizarov apply over intramedullary nail (IMN) in situ for aseptic non-union of femur. In this study, we discussed the role of this tool (AM) for the treatment of femoral shaft non-union and re-fracture with quiescent infection place plate (DCP) in situ.

Bipaddled Pectoralis Major Myocutaneous Flap in Complex Oral Cancer Defects- A Single Center Experience with Quality of Life Assessment.

Advanced stage malignancies of oral cavity commonly result in complex full thickness defects with subsequent functional and aesthetic loss. Through this article we describe our center's experience in reconstruction of such defects with bipaddled pectoralis myocutaneous (PMMC) flap through an immediate, single-staged procedure. The study included a total of 54 patients who underwent composite resection and neck dissection followed by reconstruction of the defect with bipaddled PMMC flap. All patients were followed up post-operatively for 1 year and were monitored for flap and donor site related complications. Using University of Washington Quality of life v4 questionnaire (UW-QOL4), we assessed the QOL of 54 patients. The mean scores were compared to other similar studies. Results: The overall complication rate was 66.6%, whereas, 33.3% patients had no complications. The most common complication was wound dehiscence seen in 31.5% of cases in the recipient site and 12.9% in the donor site. Other complications were seroma, hematoma, plate exposure, orocutaneous fistula etc. Around 73.7% patients reported a good, very good or outstanding overall quality of life in the post-operative period. The mean composite QOL score was 65.84. Our study showed comparable domains of pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder function and taste with other similar studies. Conclusion: Bipaddled PMMC flap proves to be a considerable alternative for microvascular free flaps in reconstruction of full-thickness defects of oral cavity owing to its reliable blood supply, accessibility, easier harvesting technique, cost effectiveness, high success rate and acceptable quality of life. The online version contains supplementary material available at 10.1007/s12070-022-03324-6.

Accurate and patient-friendly intraoperative lung nodule localization method for sublobar resection using a hybrid operating room.

A hybrid operating room (OR) is an OR that uses advanced imaging techniques, such as multidetector computed tomography (CT), cone-beam computed tomography (CBCT), fluorescence imaging and magnetic resonance imaging [1]. Hybrid ORs were originally developed for cardiovascular surgery, but they are now used for many other clinical areas including thoracic surgery, neurosurgery, vascular surgery, urology and orthopaedic surgery. In thoracic surgery, a hybrid OR has been used as an intraoperative localization method for pulmonary nodules that are difficult to identify visually or by finger palpation. Yang et al. [2] reported a feasibility study of single-stage augmented fluoroscopic bronchoscopy localization and thoracoscopic resection of small pulmonary nodules in a hybrid OR. Their localization method had 2 main characteristics: a single-stage procedure performed in a hybrid OR and marking under an augmented fluoroscopic bronchoscopy. Marking is important for localizing small pulmonary nodules that are otherwise difficult to identify intraoperatively, especially subsolid nodules or deep-seated nodules.

Single-stage sampling procedure for heteroscedasticity analysis of means

The analysis of means (ANOM) is a method that can compare the mean of each treatment to the overall mean. According to the graphical result of a statistical data analysis, we can specify which one is different from another. One of the assumptions of the classical ANOM model is that the variances are equal. However, it is not always true for the practice. To solve unknown and unequal population variances, Nelson and Dudewicz (2002) proposed a two-stage sampling procedure. However, additional samples need to be added in the second stage of the two-stage sampling procedure, so it is not practical all the time due to limited time and insufficient budget. Thus, under heteroscedasticity, we applied Chen and Lam’s (1989) single-stage sampling procedure to solve the drawback of the two-stage sampling procedure. In addition, we also provided an illustrative example and critical values for practical uses. In order to make the procedure user-friendly, we built an interface by using R Shiny.

Hajek and Hirsch: Otolaryngology Pioneers of Endonasal Transsphenoidal Pituitary Surgery.

To evaluate the historical descriptive origins of the extracranial transnasal transsphenoidal route to the sphenoid sinus and sella turcica focusing on the works of two otolaryngologists: Markus Hajek (1861-1941) and Oskar Hirsch (1877-1965). A collection of primary references of author publications, and contemporary references and textbooks. Primary references were reviewed with specific focus on surgical routes to the sphenoid sinus and sella turcica. Chronology was cross-referenced with contemporary publications by contemporaries. Translations from German were conducted by author AM when necessary. Markus Hajek elegantly described the surgical approach to the posterior ethmoids and sphenoid sinus in 1904 using a transnasal route. Building on this foundation, Oskar Hirsch described the fully extracranial endonasal transethmoid transsphenoidal approach in 1909. He was first to describe surgical entrance to the sella using this exclusively unilateral endonasal route, which he demonstrated on a cadaver. He reports performing this procedure on a live patient in April, 1910, under local anesthesia in stages over 5 weeks. For better exposure, Hirsch consolidated his method with Killian's submucosal window resection of the posterior nasal septum allowing for bilateral access to the sphenoid sinus and sella, and completed a single stage procedure on a patient in June 1910. Oskar Hirsch was the first to describe and perform a stepwise surgical approach to the sella using an exclusively extracranial, endonasal, transethmoid, and transsphenoidal approach. He built upon his mentor Markus Hajek's approaches to the posterior ethmoid cells and sphenoid sinus. NA: Background information, synthesis from multiple sources emphasizing factual information Laryngoscope, 133:807-813, 2023.

Bilateral talocalcaneal tarsal coalition with flatfeet treated with single-stage coalition resection and calcaneal lengthening osteotomy: A case report

A coalition is a bridge connecting osseous structures. Tarsal coalitions typically involve talocalcaneal and calcaneonavicular joints. As a result, patients might present with pain and/or rigid flatfoot deformity. We outline a case of bilateral middle facets talocalcaneal tarsal coalition with rigid flatfeet who was treated with resection combined with flatfoot reconstruction. the patient was an 11-year-old Saudi girl who had progressive bilateral flatfoot for which non-operative treatment failed. A single-stage middle facet talocalcaneal coalition resection with concomitant Evans calcaneal lengthening osteotomy and gastrocnemius recession was performed. Postoperatively, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle midfoot score was measured, and the patient had a score of 90/100. The outcome was satisfactory, and the other foot was operated on 6 months later, with the same procedure and outcome (AOFAS: 90/100). Six years of follow-up showed no recurrence and a satisfactory lifestyle with no activity limitation. We aimed to highlight the AOFAS score 6 years after resecting the coalitions while reconstructing the foot in a single-staged procedure.

The impact of agricultural extension type and form on technical efficiency under transition: An empirical assessment of wheat production in Uzbekistan

Agricultural Extension Services (AES) have the potential to increase agricultural productivity and sustainability. Although an extensive body of literature investigates into the impact of AES on technical efficiency in agricultural production, analyses of the combined effect of extension types and forms are still hard to come by within the international literature. Using the example of wheat farmers in Uzbekistan, this study is the first to assess the combined impact of extension types and forms. Using cross-sectional data for 323 wheat farmers, we employ a single-stage Maximum Likelihood procedure for a stochastic frontier production function for three different specifications. Specifically, extension frequency, type of extension systems, and a set of extensionist participatory approaches are purposefully distinguished in the analysis alongside other farm characteristics and observed covariates. Our study found that there are still considerable technical efficiency gaps in wheat production. In particular, aside farmers’ characteristics, the frequency of extension visits and extension participatory approaches are significant in explaining technical efficiency differences among wheat farmers in Uzbekistan and would thus be conducive to close mentioned efficiency gaps. We suggest that under a simplified state regulatory framework, a well-structured system of AES should be client-oriented, cost-efficient, and demand-driven. In order to close existing inefficiency gaps, all farmers should have access to participatory extension services.

Single-stage augmented fluoroscopic bronchoscopy localization and thoracoscopic resection of small pulmonary nodules in a hybrid operating room.

Hybrid operating rooms (HOR) have been increasingly used for image-guided lung surgery, and most surgical teams have used percutaneous localization for small pulmonary nodules. We evaluated the feasibility and safety of augmented fluoroscopic bronchoscopy localization under endotracheal tube intubation general anaesthesia followed by thoracoscopic surgery as a single-stage procedure in ab HOR. We retrospectively reviewed clinical records of patients who underwent single-stage augmented fluoroscopic bronchoscopy localization under general anaesthesia followed by thoracoscopic surgery in an HOR between August 2020 and March 2022. Single-stage localization and resection were performed for 85 nodules in 74 patients. The median nodule size was 8 mm [interquartile range (IQR), 6-9 mm], and the median distance from the pleural space was 10.9 mm (IQR, 8-20 mm). All nodules were identifiable on cone-beam computed tomography images and marked transbronchially with indigo carmine dye (median markers per lesion: 3); microcoils were placed for deep margins in 16 patients. The median localization time was 30 min (IQR 23-42 min), and the median fluoroscopy duration was 3.3 min (IQR 2.2-5.3 min). The median radiation exposure (expressed as the dose area product) was 4303.6 μGym2 (IQR 2879.5-6268.7 μGym2). All nodules were successfully marked and resected, and the median global operating room time was 178.5 min (IQR 153.5-204 min). There were no localization-related complications, and the median length of postoperative stay was 1 day (IQR, 1-2 days). Single-stage augmented fluoroscopic bronchoscopy localization under general anaesthesia followed by thoracoscopic surgery was feasible and safe.

Labyrinthine Fistula in Chronic Otitis Media Surgery: Management and Outcomes.

The objective of this retrospective study was to present the experience on the management of labyrinthine fistula secondary to chronic otitis media in a tertiary center. 263 patients, who underwent tympanomastoidecomy, in Centro Hospitalar Universitário do Porto, between 2015 and 2020 were reviewed, to select only those with labyrinthine fistulas. 26 patients (9.89%) had cholesteatoma complicated by fistula of the lateral semicircular canal. Most frequent symptoms were unspecific, such as otorrhea, hearing loss and dizziness. Preoperative high-resolution computed tomography predicted fistula in 54%. Using the Dornhoffer and Milewski classification, 10 cases (38.46%) were identified as stage I, 15 (57.69%) at stage II, and 1 (3.85%) as stage III. The choice between open or closed surgical procedure was independent of the type of fistulae. The cholesteatoma matrix was completely removed from the fistula and immediately covered by autogenous material. In one patient matrix was left over the fistula. After surgery, hearing (bone conduction) was preserved or improved in 73% of the patients. There was no statistically significant relationship between the extent of the labyrinthine fistula, type of material used in fistula repair and the hearing outcome. Also, we didn't find a statistically significant relationship between extent of the labyrinthine fistula and the presence of facial nerve canal dehiscence, tegmen timpani erosion, sigmoid sinus exposure or ossicular bone erosions. In conclusion, a complete and nontraumatic removal of cholesteatoma matrix over the fistula in a single-staged procedure, is a safe and effective procedure, which achieves a hearing preservation or improvement in most cases.

Infection after total joint replacement of the hip and knee: research programme including the INFORM RCT

Infection after total joint replacement of the hip and knee: research programme including the INFORM RCT

Clinical and cost effectiveness of single stage compared with two stage revision for hip prosthetic joint infection (INFORM): pragmatic, parallel group, open label, randomised controlled trial

ObjectivesTo determine whether patient reported outcomes improve after single stage versus two stage revision surgery for prosthetic joint infection of the hip, and to determine the cost effectiveness of these...