Sixth Postoperative Week Research Articles

Structural and functional macular changes after cataract surgery in diabetic patients

Introduction. In recent years, the number of diabetic patients requiring cataract surgery has been on the rise. The aim of this study was to examine the effects of cataract surgery on visual acuity and changes in the central retinal thickness in diabetic patients with and without retinopathy, in relation to the duration of the disease, type of therapy, and the level of glycated hemoglobin and serum lipids. Material and Methods. The prospective study included 51 eyes of 34 patients divided into three groups. Preoperatively, all patients underwent best-corrected visual acuity evaluation with Snellen chart, cataract grading using lens opacities classification system III, as well as fundus examination and optical coherence tomography. Postoperative follow-up visits were scheduled after the first, fourth, sixth, eighth, and twelfth weeks after which the patients underwent best-corrected visual acuity evaluation and optical coherence tomography. The obtained values were statistically processed and analyzed in relation to the duration of the disease, the type of therapy, and the level of glycated hemoglobin and serum lipids. Results. Of 51 eyes, 5.9% developed macular edema during the fourth postoperative week with central retinal thickness > 310 ?m. Subclinical central retinal thickness changes were registered in all groups with the highest values in group I (diabetics with retinopathy) in the sixth postoperative week. The average value of central retinal thickness in group I was 256 ? 11 ?m at baseline and 273 ? 11 ?m in week 6. The best-corrected visual acuity improved in all groups, without changes in central retinal thickness. Conclusion. Good visual acuity and absence of significant changes in macular thickness are helpful when making the decision to perform cataract surgery in patients with diabetes. Postoperative follow-up visits should include optical coherence tomography in addition to standard procedures.

A Suspicious Atypical Fracture of 5th Metatarsal Bone: A Case Report

Category:TraumaIntroduction/Purpose:Long-term usage of bisphosphonate can severely suppress bone turnover and alter bone mechanical properties, thereby resulting in atypical fractures that mainly occur at the femur.We present a rare case of suspicious atypical fracture of the metatarsal bone.Methods:A 63-year-old woman presented to our clinic with a primary complain of a one-week history of pain in her right foot. The patient had no history of trauma to the right foot and denied any strenuous activity. She experienced lateral foot pain while walking within her home. She was on alendronate therapy for osteoporosis for a decade. X ray and CT examination revealed a fifth metatarsal fracture whose features were compatible with those of atypical femoral fractures (Figure 1).Results:The patient was advised to discontinue alendronate and underwent percutaneous surgical fixation of the fracture via a proximal approach using a 4.0-mm half-threaded cannulated screw. Postoperatively, a short leg cast was created and the patients performed non-weight bearing ambulation until the cast was removed at the sixth postoperative week. Radiography in the sixth postoperative week revealed callus formation.Conclusion:Our findings suggest that physicians must keep in mind that atypical fractures could possibly occur at bones other than the femur.

The Effects of Total Knee Arthroplasty on Sleep Quality.

Introduction: Symptomatic osteoarthritis is one of the most common indications for total knee arthroplasty (TKA) operations. Pain in every stage of the disease causes sleep disturbances in patients. The primary objective of this study was to evaluate the effect of TKA on the quality of sleep in patients with symptomatic osteoarthritis.Materials and Methods: This retrospective, descriptive study was performed on 80 patients diagnosed with symptomatic osteoarthritis who underwent TKA. The patients responded to the Pittsburgh Sleep Quality Index (PSQI), which is widely used to evaluate sleep quality. Additionally, the effects of demographic and clinical variables such as age, gender, body mass index, smoking and alcohol consumption were also evaluated before and after surgery.Results: There was no correlation between demographic variables and PSQI scores pre- and postoperatively. There was a decrease in sleep quality on the sixth postoperative week compared to the preoperative period however this difference was not statistically significant. On the other hand, there was a statistically significant difference between preoperative and postoperative sixth month PSQI scores. Mean values of overall sleep quality and daily function were significantly higher in the postoperative sixth compared to the preoperative period (p<0.001)Conclusion: Treatment of symptomatic OA with TKA will improve sleep quality in the long term.

Radial neck fractures in children: A surgical tip using the Metaizeau technique to improve stability of the reduction

AimTo evaluate early results of management of radial neck fractures with Métaizeau technique in the paediatric age group and to elaborate on a surgical tip to improve stability of the fixation. MethodA retrospective analysis of 21 patients, with fracture radial neck, who underwent closed reduction and internal fixation with elastic intramedullary nailing (Métaizeau technique), was performed. Mean age at injury was eight years, and the average follow-up was 4.5 months (range: 3–6 months). Follow up Clinical and radiological evaluation was performed at first and sixth postoperative weeks. At six weeks following removal of the nail, a clinical assessment was conducted to record the outcomes, and any later follow-up was arranged based on pain and range of motion. ResultsWe recorded five excellent, eight good, one fair, results for type 3 fractures. For type 4 fractures, we had one excellent, five good and one fair, results. Altogether, we recorded 20 (90.5%) excellent or good results, and 2 (9.5%) fair results. Complications noted were superficial skin infection at the entry site in one patient that required a course of oral antibiotics. Prominent metal work was noticed in 14 cases, which didn't need any further intervention as it did not cause any functional discomfort. ConclusionWith Metaizeau technique, there were reported poor results of about 10% in literature. In our study, with the modification of the shape of the nail tip, we have managed to achieve stable fixation of the reduction without any loss of position and consequently, better outcomes.

English

AIM OF THE STUDY: To clinically analyse visual outcome and intraocular pressure control in surgically treated cases of lens induced glaucoma. MATERIALS AND METHODS: 100 patients with LENS INDUCED GLAUCOMA attending glaucoma services of Regional Institute of Ophthalmology and Government Ophthalmic Hospital were included in the study. Patients with presence of phacolytic, phacomorphic, lens particle, phaco anaphylaxis glaucoma and subluxated or dislocated lens with elevated intraocular pressure were included in the study. Patients with previous history of Primary Open Angle glaucoma and primary angle closure glaucoma, other secondary glaucomas, uncontrolled diabetes and IHD were excluded. All were subjected to detailed anterior segment examination, best corrected visual acuity, intraocular pressure measurement either by Goldmann applanation tonometry or in cases with presence of corneal edema rebound tonometry reading was recorded, fundus examination, gonioscopic examination were done. Surgical procedures like SICS/ECCE or combined surgery in cases with peripheral anterior synechiae or lens removal with secondary iol implantation were done. Surgical complications were analysed in patients undergoing sics/ecce/lens removal with secondary IOL and combined surgery and followed up periodically with visual acuity and intraocular pressure measurements and gonioscopic examination. RESULTS: In our study, 52% cases were in the age group of 56 -60 years, there was a slight male preponderance (59%), 47% presented with an IOP of 28-32mmhg. 60% cases were phacolytic glaucomas, 29% were phacomorphic glaucomas, 10% were lens particle glaucomas, 1% was due to subluxated lens induced glaucoma. 72% cases had PCIOL in other eye, 57% had a visual acuity in 6/36-6/18 range in other eye. At the end of six weeks the visual acuity for maximum number of cases (55%) was in the range 6/36-6/18, 20% cases had vision of range 3/60-6/60, 20% cases had vision of range 6/12-6/9. Hence visual improvement occurred in 95% of cases at the end of sixth post-operative week. 68% of cases had striate keratopathy, Post-operative iritis was present in all cases (100%), zonular dehiscence occurred in 43% cases, 12% cases had posterior capsular rent and 5% cases had vitreous loss. Out of 10 lens particle glaucoma cases, 50% (5 cases) had a good vision of 6/12 when compared to other types of lens induced glaucoma. Intraocular pressure was in the range of 12-14mmhg in 60% cases, 16-18mmhg in 40% cases at the end of six weeks. CONCLUSION: In our study, most of the patients had good vision in fellow eye and PCIOL status. This shows that patients ignored the reduced vision in affected eye due to good vision in fellow eye so their daily life was not affected until they developed symptoms. In lens induced glaucoma, surgery is the main stay of treatment after adequate control of intraocular pressure and inflammation with medications. Following surgery, intraocular pressure reduction occurs in all cases and visual improvement occurs in 95% cases.

Continuous Passive Motion Does Improve Range of Motion, Pain and Swelling After ACL Reconstruction: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis evaluates the results of empirical studies on the effects of CPM on rehabilitation after ACL reconstruction. The research question was: what are the effects of CPM on ROM, swelling and pain after ACL reconstruction? We searched in MEDLINE, Embase, CINAHL, Cochrane and PEDro up to January 2018. Standardized mean differences (SMD) were expressed as Hedges' g, in order to correct for overestimation of the true effect in small study samples. The 95% confidence intervals (95% CI) were calculated for both the individual studies and the overall weighted estimate. Outcomes were range of motion, pain and swelling. Eight studies comprising 442 participants were included in the meta-analysis. Beneficial effects of CPM could be identified for the need for pain medication (Hedges' g = 0.93; 95% CI = 0.41 to 1.45 during the first 24 hours after surgery), the number of PCA button pushes by the patient during the first 24 hours after surgery (MD = 31.20; 95% CI = 11.35 to 51.05), on regaining knee flexion on the third to the seventh postoperative day (MD = 11.6°; 95% CI = 1.96 to 21.33) as well as in the third to the sixth postoperative week (Hedges' g = 0.93; 95% CI = 0.41 to 1.44) and on swelling of the knee in the fourth to sixth postoperative week (Hedges' g = 0.77; 95% CI = 0.35 to 1.18). This meta-analysis suggests that CPM has beneficial effects on pain reduction during the first two postoperative days, on knee flexion during the first to the sixth postoperative weeks and on swelling between the fourth and the sixth postoperative weeks. However, the risk-of-bias scores do not allow a high level of evidence.

Carotid-Jugular Fistula Model to Study Systemic Effects and Fistula-Related Microcirculatory Changes

Background: Arteriovenous fistulae impair the distal circulation, but their effects at the microcirculatory level are not well understood. This study presents the carotid-jugular fistula (CJF) as a model to evaluate fistula-related microcirculatory and systemic changes. Materials and Methods: Female Wistar rats were anesthetized and divided into a fistula group (FG, n = 10) and a sham group (SG, n = 6). End-to-end anastomosis was performed between the right carotid artery and the jugular vein in the FG. The hemodynamic status was followed for 6 weeks. On the sixth postoperative week, liver and kidney microcirculation was measured using laser Doppler; then microcirculatory changes were assessed after occlusion of the carotid artery. At the end of the experiment, histological samples were taken and the weights of the organs were measured. Results: The heart rate and systolic blood pressure decreased significantly due to the CJF. Laser Doppler showed a reduction in liver blood flow units (BFU) in the FG in comparison with the SG (p = 0.01), and they increased (p < 0.01) after occlusion of the fistula. Kidney BFU showed slight changes only. The comparative morphological study revealed significant increases in heart weight (p < 0.001) and left ventricular hypertrophy (p = 0.008) in the FG. Conclusion: Beside hemodynamic and morphologic changes, a CJF causes a deterioration in the microcirculation of the liver rather than of the kidney, but occlusion of the CJF immediately reverses these changes.

Early Versus Delayed Double J Stent Removal in Deceased Donor Renal Transplant Recipients: A Prospective Comparative Study.

Introduction: Prophylactic ureteric stents have been commonly employed to reduce the incidence of ureteric obstruction and anastomotic leaks following renal transplantation. There are very few studies on the duration of ureteric stenting in deceased donor renal transplantation (DDRT). We performed a prospective study to compare early and late double J stent removal in DDRT.Aims and methods: The aim of this study was to compare the early and delayed removal of ureteric stents after DDRT. We performed 80 DDRTs at our center from August 2012 to December 2016, which were included in the study. However, we enrolled 48 patients as the remaining had to be excluded based on the high-risk factors. The recipients were allocated on the 14th postoperative day to two groups. Group 1 underwent early stent removal on the fourteenth postoperative day and in group 2, the stent was removed in the sixth postoperative week. The two groups were followed up for six months and the incidence of urological complications and urinary tract infections (UTI) was compared.Results: The incidence of UTI during the follow-up period of six months was significantly lower in the early stent removal group (two out of 24) than in delayed stent removal group (eight out of 24) (p=0.016). Asymptomatic bacteriuria occurred in six out of 24 (25%) in group 1 and 10 out of 24 (41.6%) in group 2 (p=0.120). There was no significant difference in the incidence of urinary leak, hematuria, or ureteric obstruction between the two groups (p=0.900). However, stent-related symptoms were significantly more in the delayed stent removal group (three in group 1 versus 18 in group 2) (p=0.001).Conclusion: Prolonged stenting is associated with an increased risk of UTI and stent-related symptoms in immunosuppressed renal transplant recipients. The early removal of double J stents can be done in carefully selected patients to reduce stent-related complications in DDRT.

Outcome of deep anterior lamellar keratoplasty patients with intraoperative Descemet's membrane perforation: A retrospective cross-sectional study.

Purpose:To evaluate functional and anatomical outcome in patients undergoing deep anterior lamellar keratoplasty (DALK) with intraoperative Descemet's membrane (DM) perforation (macro and micro).Methods:A retrospective cross sectional study (January 2009 to December 2015) of sixteen eyes of sixteen patients which included nine patients of advanced keratoconus (KC), two patients with paracentral DM scarring post hydrops, KC with Bowman's membrane scarring, macular corneal dystrophy and one patient of advanced Pellucid Marginal Degeneration (PMD). All underwent DALK with intraoperative DM perforation. Big bubble technique was attempted in all except in the two patients with post hydrops DM scar. Preoperative and postoperative best corrected visual acuity (BCVA), astigmatism and endothelial count (EC) were compared.Results:Postoperative BCVA and astigmatism were found to be better and statistically significant (’p value’ 0.00 and 0.003 respectively). BCVA preoperative and postoperative was 1.07± 0.3 and 0.28 ± 0.09 in LogMAR respectively and astigmatism pre and postoperative 4.14 ± 1.5 D and 2.7 ± 0.97 D respectively. Percentage decrease in EC at sixth postoperative week was 7.48% and at sixth month and 1 year postoperative was 15.1%. Two patients developed postoperative double anterior chamber and two patients developed pupillary block glaucoma and all were successfully managed.Conclusion:Not all patients of intraoperative DM perforation (including macro perforation) needs to be converted to penetrating keratoplasty. DALK can be successfully done if the perforation is identified early and managed adequately. This is the only known study which has shown a large series of successful DALK even with macro perforations.

Treatment of Mandibular Angle Fractures with Single Three-Dimensional Locking Miniplates without Maxillomandibular Fixation: How Much Fixation Is Required?

The aim of this simple nonrandomized and observational study was to evaluate the efficacy of single three-dimensional (3D) plate for the treatment of mandibular angle fractures without maxillomandibular fixation. A total of 30 patients with noncomminuted fractures of mandibular angle requiring open reduction and internal fixation were included in the study. All the patients were treated by open reduction and internal fixation using single 3D titanium locking miniplate placed with the help of transbuccal trocar or Synthes 90-degree hand piece and screw driver. 3D locking titanium miniplates used in our study was four-holed, box-shaped plate, and screws with 2 mm diameter and 8 mm length. The following clinical parameters were assessed for each patient at each follow-up visit: pain (visual analog scale: 0-5), swelling (visual analog scale: 0-5), mouth opening, infection, paresthesia, hardware failure (plate fracture), occlusal discrepancies, and mobility between fracture fragments. A significant decrease in pain level was seen during the follow-up visits. No statistically significant changes were seen in swelling, but mouth opening increased in the subsequent visits. Also better results were seen in terms of fracture stability and occlusion in the postoperative period. Two cases of infection and two cases of hardware failure were noted in sixth postoperative week. 3D plating system is an easy to use alternative to conventional miniplates to treat mandibular angle fractures that uses lesser foreign material, thus reducing the operative time and overall cost of the treatment. Better fracture stability and occlusion was also achieved using the 3D plating system.

Patient compliance with touchdown weight bearing after microfracture treatment of talar osteochondral lesions

BackgroundThe aim of this study was to prospectively evaluate the compliance of our patients with a touchdown weight bearing (without supporting any weight on the affected side by only touching the plantar aspect of the foot to the ground to maintain balance to protect the affected side from mechanical loading) postoperative rehabilitation protocol after treatment of talar osteochondral lesion (TOL).MethodsFourteen patients, who had been treated with arthroscopic debridement and microfracture, were followed prospectively. The patients were evaluated for weight bearing compliance with using a stationary gait analysis and feedback system at the postoperative first day, first week, third week, and sixth week.ResultsThe mean visual analog scale (VAS) scores of the patients at the preoperative, postoperative first day, first week, third week, and sixth weeks were 5.5, 5.9, 3.6, 0.9, and 0.4, respectively. The decrease in VAS scores were statistically significant (p < 0.0001). First postoperative day revealed a mean value of transmitted weight of 4.08% ±0.8 (one non-compliant patient). The mean value was 4.34% ±0.8 at the first postoperative week (two non-compliant patients), 6.95% ±2.3 at the third postoperative week (eight non-compliant patients), and 10.8% ±4.8 at the sixth postoperative week (11 non-compliant patients). In the analysis of data, we found a negative correlation between VAS scores and transmitted weight (Kendall’s tau b = −0.445 and p = 0.0228).ConclusionsAlthough patients were able to learn and adjust to the touchdown weight bearing gait protocol during the early postoperative period, most patients became non-compliant when their pain was relieved. To prevent this situation of non-compliance, patients should be warned to obey the weight bearing restrictions, and patients should be called for a follow-up at the third postoperative week.

Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy.

PurposeThe purpose was to compare the accuracy of Miniaci method using picture archiving and communication system (PACS) with a cable method in high tibial osteotomy (HTO).Materials and MethodsThis study analyzed 47 patients (52 knees) with varus deformity and medial osteoarthritis. From 2007 to 2013, patients underwent HTO using either a cable method (20 knees) or Miniaci method based on a PACS image (32 knees). In the cable method, the 62.5% point of the mediolateral tibial plateau width was located using an electrocautery cord under fluoroscopy (cable group). The Miniaci method used preoperative radiographs to shift the weight bearing axis (PACS group). Full-length lower limb radiographs obtained preoperatively and at the sixth postoperative week were used to compare the percentage of crossing point of the weight bearing line on the tibial plateau with respect to the medial border.ResultsThe weight bearing line on the tibial plateau was corrected from a preoperative 11.0±7.0% to a postoperative 47.2±7.4% in the cable group and from 12.7±4.9% to 59.5±5.3% in the PACS group. The mechanical femorotibial angle was corrected from varus 8.9±3.7° to valgus 0.3±4.0° in the cable group and from varus 9.0±3.3° to valgus 2.9±2.6° in the PACS group.ConclusionsIn HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method.

Double-Chamber Tissue Expanders Optimize Lower Pole Expansion in Immediate Breast Reconstruction Requiring Adjuvant Radiation Therapy.

Tissue expander-based reconstruction in the irradiated breast has been associated with significant complications, including infection, skin breakdown and implant extrusion, and poor aesthetic outcome. These complications may be attributed to inadequate lower pole expansion causing increased pressure on the suture line. Achieving and maintaining adequate lower pole expansion in the reconstructed breast requiring adjuvant radiation therapy may reduce the pressure/strain on the suture line and preserve the natural appearance of the breast. We describe the effective use of a double-chamber tissue expander to control lower pole expansion in immediate breast reconstruction requiring adjuvant radiation therapy. We performed a retrospective chart review of patients who underwent postoperative radiation therapy after immediate breast reconstruction using Sientra's double-chamber tissue expander, performed by a single plastic surgeon from 2012 to 2014. A total of 22 patients met our inclusion criteria. Seventeen patients had bilateral, and 5 patients had unilateral reconstruction (n = 39 total breasts). All patients were over expanded by 20% on the side affected by cancer before the start of radiation, which started by the sixth postoperative week. There was no expansion during radiation therapy. Two patients had further expansion after radiation therapy was completed. The tissue expanders were exchanged for shaped silicone gel implants 3 to 4 months after completion of radiation. A total of 2 complications occurred in 2 patients (9.0%) and 2 breasts (5.1%). These included an infection in one patient and a tissue expander leak in another. No patient developed Baker grade 3 or 4 capsular contracture, seroma, or device malposition. Good lower pole contour and projection was maintained in all breasts at 9 to 12 months of follow-up. The double-chamber tissue expander is effective in controlling shape, contour, and position of the breast following immediate tissue expander reconstruction requiring adjuvant radiation therapy, with decreased complication rates compared to standard expanders. These results suggest that double-chamber tissue expanders may be the preferred expander option in patients requiring adjuvant radiation therapy. Prospective clinical studies are needed to better evaluate the advantages of this reconstructive approach.

Prospective correlation of multinational association for supportive care in cancer risk index score with outcomes in neutropenic fever

Objectives: The aim of the study was evaluate the effect of gynecologic cancer treatment on urinary incontinence symptoms. Methods: This study included 76 patients who underwent gynecologic radical surgery for endometrial cancer and ovarian cancer. Preoperatively, a urogynecologic examination and Urinary Incontinence Score for Females test were performed. Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory-6 (UDI-6) were performed before treatment and at the sixth week after surgery for all patients. Results: The mean age and parity of patients were 57.7 ± 10.5 years and 2.6 ± 1.2. A total of 44 patients (57%)were diagnosedwith stress or urge incontinence by examination or Urinary Incontinence Score for Females' test. The percentages of patients with stress urinary incontinence and urge incontinence were 52.3% and 9%, respectively. The percentage of mixed incontinence was 38.7%. Twenty-four of 76 procedures (31%) were performed for ovarian cancer and 52 (69%) procedures were performed for endometrial cancer. There was no urinary tract injury during procedures. The percentage of urinary incontinence at the sixth postoperative week was 71% and the difference was significant (P b 0.05). The difference between preoperative and postoperative IIQ-7 and UDI-6 scores was significant (P b 0.05). There was no significant difference in a comparison of the items of physical activity and travel on the IIQ-7 test. Conclusions: Radical gynecologic surgery has serious adverse effects on urinary continence. Urinary symptoms could impair quality of life after surgery. Urinary incontinence is one of the important symptoms of pelvic organ prolapse. Neural injuries, muscle injuries, radiotherapy, or edema could be the source of pelvic organ prolapse and incontinence. Preventive approaches should be suggested to patients early after surgery.

Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures: Early results of a case series

IntroductionOsteoporotic tibial plateau fractures (TPFs) are difficult to treat with either open reduction internal fixation (ORIF) or acute total knee arthroplasty (TKA). They have high complication rates, poor outcomes and often fail in the short- to mid-term. We investigated the use of impaction bone grafting (IBG) as an adjunct to stabilise the fracture in a cohort of osteoporotic TPFs. MethodsNine consecutive osteoporotic TPFs were surgically stabilised with ORIF augmented with IBG or with IBG alone (one pure depression fracture) using on average allograft from 2 femoral heads/case (range 1–4 heads or 25–100cm3). The median bone mineral density T-score of the patients was −2.9 (−2.5 to −4.5). All patients were mobilised weight-bearing as tolerated immediately after surgery and had regular follow-up to a minimum of 2 years where functional scores were taken and gait was assessed. Fracture reduction was assessed on plain radiographs and computed tomography (CT) scans; maintenance of fracture reduction was monitored using plain radiographs, CT and radiostereometric analysis (RSA). Bone graft remodelling was assessed by comparison of immediate post-operative CT scans with scans at a minimum of 1 year. ResultsAll surgeries were uneventful. All patients progressed to full weight bearing within 6 weeks of surgery and regained a normal gait by 3 months. Seven fractures healed with a cranio-caudal migration of less than 3mm (range 0–2.6mm using RSA and 0–2mm using CT). Two fractures had an isolated posterolateral fragment depression of 13.5mm and 9mm, respectively, which did not affect the overall joint alignment or clinical outcomes at short-term follow-up. At latest CT follow-up, on average 51% of the graft area (range 36–70%) had remodelled into new host bone. ConclusionImpaction bone grafting shows promising results as an adjunct to the surgical stabilisation of osteoporotic TPFs. In this case series the technique provided enough fracture stability for patients to mobilise weight-bearing as tolerated immediately after surgery and achieve full weight-bearing by the sixth postoperative week. There was no failure of fixation and 7 of the 9 cases healed with minimal fracture displacement.

Demineralized Bone Matrix Injection in Consolidation Phase Enhances Bone Regeneration in Distraction Osteogenesis via Endochondral Bone Formation.

BackgroundDistraction osteogenesis (DO) is a promising tool for bone and tissue regeneration. However, prolonged healing time remains a major problem. Various materials including cells, cytokines, and growth factors have been used in an attempt to enhance bone formation. We examined the effect of percutaneous injection of demineralized bone matrix (DBM) during the consolidation phase on bone regeneration after distraction.MethodsThe immature rabbit tibial DO model (20 mm length-gain) was used. Twenty-eight animals received DBM 100 mg percutaneously at the end of distraction. Another 22 animals were left without further procedure (control). Plain radiographs were taken every week. Postmortem bone dual-energy X-ray absorptiometry and micro-computed tomography (micro-CT) studies were performed at the third and sixth weeks of the consolidation period and histological analysis was performed.ResultsThe regenerate bone mineral density was higher in the DBM group when compared with that in the saline injection control group at the third week postdistraction. Quantitative analysis using micro-CT revealed larger trabecular bone volume, higher trabecular number, and less trabecular separation in the DBM group than in the saline injection control group. Cross-sectional area and cortical thickness at the sixth week postdistraction, assessed using micro-CT, were greater in the regenerates of the DBM group compared with the control group. Histological evaluation revealed higher trabecular bone volume and trabecular number in the regenerate of the DBM group. New bone formation was apparently enhanced, via endochondral ossification, at the site and in the vicinity of the injected DBM. DBM was absorbed slowly, but it remained until the sixth postoperative week after injection.ConclusionsDBM administration into the distraction gap at the end of the distraction period resulted in a significantly greater regenerate bone area, trabecular number, and cortical thickness in the rabbit tibial DO model. These data suggest that percutaneous DBM administration at the end of the distraction period or in the early consolidation period may stimulate regenerate bone formation and consolidation in a clinical situation with delayed bone healing during DO.

Characterization of Pain After Inside-Out Transobturator Midurethral Sling

This study aimed to evaluate the prevalence, severity, duration, and location of pain after transobturator midurethral sling. We evaluated patients who underwent inside-out transobturator sling from March 2011 through February 2013. Presence of pelvic girdle pain, its severity, and location were documented preoperatively and at 2- and 6-week postoperative visits. Pain severity was measured on a scale of 1 to 10, with 10 being the "worst imaginable" pain. Of the 130 women analyzed, the median age was 50.0 years (interquartile range, 44.0-62.0). Thirty-nine percent of women reported preoperative pain, mostly mild with a median score of 1.0 (1.0-5.0). The most common sites of postoperative-onset pain were the lateral leg, medial leg, groin, and low back. Women reporting preoperative pain were not more likely to report postoperative-onset pain than women without preoperative pain (P = 0.42). Twelve percent of women at 2 weeks and 0.8% at 6 weeks reported severe postoperative-onset pain. Women reporting postoperative-onset pain were equally likely to be satisfied with the procedure as those without pain at 2 (P = 0.76) and 6 (P = 0.74) weeks. Women undergoing transobturator sling commonly report preoperative pain. An expected postoperative increase in pain generally resolved by the sixth postoperative week. The lateral leg was the most common site of pain. Postoperative-onset pain was not associated with decreased patient satisfaction.

Cost Differences Among Robotic, Vaginal, and Abdominal Hysterectomy

To compare the costs of vaginal and abdominal hysterectomy with robotically assisted hysterectomy. We identified all cases of robotically assisted hysterectomy, with or without bilateral salpingo-oophorectomy, treated at the Mayo Clinic (Rochester, Minnesota) from January 1, 2007, through December 31, 2009. Cases were propensity score-matched (one-to-one) to cases of vaginal and abdominal hysterectomy, selected randomly from January 1, 2004, through December 31, 2006 (before acquisition of the robotic surgical system). All billed costs were abstracted through the sixth postoperative week from the Olmsted County Healthcare Expenditure and Utilization Database and compared between cohorts with a generalized linear modeling framework. Predicted costs were estimated with the recycled predictions method. Costs of operative complications also were estimated. The total number of abdominal hysterectomies collected for comparison was 234 and the total number of vaginal hysterectomies was 212. Predicted mean cost of robotically assisted hysterectomy was $2,253 more than that of vaginal hysterectomy ($13,619 compared with $11,366; P<.001), although costs of complications were not significantly different. The predicted mean costs of robotically assisted compared with abdominal hysterectomy were similar ($14,679 compared with $15,588; P=.35). The costs of complications were not significantly different. Overall, vaginal hysterectomy was less costly than robotically assisted hysterectomy. Abdominal hysterectomy and robotically assisted hysterectomy had similar costs. II.

The longitudinal assessment of osteomyelitis development by molecular imaging in a rabbit model.

Introduction. Osteomyelitis is a severe orthopaedic complication which is difficult to diagnose and treat. Previous experimental studies mainly focussed on evaluating osteomyelitis in the presence of an implant or used a sclerosing agent to promote infection onset. In contrast, we focused on the longitudinal assessment of a nonimplant related osteomyelitis. Methods. An intramedullary tibial infection with S. aureus was established in NZW rabbits. Clinical and haematological infection status was evaluated weekly, combined with X-ray radiographs, biweekly injections of calcium binding fluorophores, and postmortem micro-CT. The development of the infection was assessed by micro-PET at consecutive time points using 18F-FDG as an infection tracer. Results. The intramedullary contamination of the rabbit tibia resulted in an osteomyelitis. Haematological parameters confirmed infection in mainly the first postoperative weeks (CRP at the first 5 postoperative weeks, leucocyte differentiation at the second and sixth postoperative weeks, and ESR on the second postoperative week only), while micro-PET was able to detect the infection from the first post-operative week onward until the end of the study. Conclusions. This study shows that osteomyelitis in the rabbit can be induced without use of an implant or sclerosing agent. The sequential follow-up indicates that the diagnostic value of each infection parameter is time point dependant. Furthermore, from all parameters used, the diagnostic value of 18F-FDG micro-PET is the most versatile to assess the presence of an orthopaedic infection in this model.

Multiple Detector Computed Tomography Scans Imaging of an Early Polytetrafluorethylene Patch Aneurysm after Tetralogy of Fallot Repair

Postoperative aneurysms of the right ventricle after correction of Tetralogy of Fallot are usually the consequence of a long standing pulmonary regurgitation or distal pulmonary obstruction. They occur more frequently in patients where a transannular incision has been initially applied. The aneurysm formation is usually slow with progressive dilatation of the anterior free wall of the right ventricle. We report a very early and unusual postoperative polytetrafluorethylene (PTFE) patch aneurysm accidentally discovered in the sixth postoperative week during the prolonged hospital stay due to a postoperative cerebral stroke. The dilatation of the right ventricular outflow tract could not be completely outlined by ultrasound, and Multiple Detector Computed Tomography scan (MDCT) gave an excellent insight to the anatomy of the aneurysm and provided the cardiac surgeon with necessary information. The patch had not been previously resterilized or damaged in any way. The explanted patch was not infected. PTFE aneurysms have been observed and studied for decades and were mostly related to PTFE grafts in vascular surgery. Creep or cold flow theories have been proposed to explain gradual stretching of the material, one of them including wall tensions dependent on the pressure and radius parameters.