Superior Method Of Treatment Research Articles

A Retrospective Cohort Study Comparing the Clinical Outcomes of the Hydrosurgery System and Traditional Single-Incision Surgery for Axillary Osmidrosis.

To compare the postoperative scarring, complication rates, and efficacy between the hydrosurgery system and traditional single-incision surgical techniques for treating axillary osmidrosis. A retrospective collection was conducted of all patients who underwent radical surgery for axillary osmidrosis at the Day Surgery Unit of the Department of Plastic Surgery at the First Affiliated Hospital of the Army Medical University from January 2023 to January 2024. Patients were screened based on inclusion and exclusion criteria and divided into the hydrosurgery group and the traditional surgery group. The evaluation was done through medical records, follow-up records, electronic questionnaires, and photographs. Assessments included 6-month postoperative scarring conditions, comprehensive effectiveness scores, postoperative odor/hair/sweating scores, postoperative dermatological life quality scores, and complication rates. A total of 73 patients completed this study: 34 in the hydrosurgery group and 39 in the traditional surgery group. 6 months postoperatively, the hydrosurgery group had significantly lower scores of the Vancouver Scar Scale (VSS), 0.5 (range 0.0-2.0) compared with 1.5 (range 0.5-3.0) in the traditional surgery group (p = 0.018). The incidence of complications such as subcutaneous hematoma, epidermal necrosis, and wound dissidence was also lower (26.5% vs. 51.3%, p = 0.031). Additionally, the surgical incision length in the hydrosurgery group was significantly smaller than in the traditional surgery group (1.200 cm (1.000, 1.275) vs. 2.500 cm (2.500, 3.000), p < 0.001). There were no significant differences between the two groups regarding comprehensive effectiveness scores, postoperative odor/hair/sweating scores, postoperative dermatological life quality index, and surgical duration. Compared with traditional single-incision surgical techniques, patients in the hydrosurgery group exhibited lower scar scores 6 months postsurgery, required smaller surgical incisions, and had lower rates of surgical complications. Thus, the hydrosurgery is suitable for the minimally invasive surgical treatment of axillary osmidrosis, offering a safe, effective, and aesthetically superior treatment method.

Comparison of the outcomes of syndesmotic ankle fractures treated with dynamic fixation versus static fixation versus fibular nail: a meta-analysis and systematic review.

Syndesmotic ankle fractures occur when there is damage to the syndesmosis complex, resulting in severe pain and instability. Treatment methods include static fixation, dynamic fixation, and fibular nailing. This systematic review and meta-analysis aims to compare the outcomes of these surgical interventions for syndesmotic ankle fractures. PubMed and Embase were searched up until April 2024 for comparison studies that included at least two of the treatment methods and relevant functional outcomes and complication metrics. Review Manager 5.4 was used for statistical analyses, and a P value ≤0.05 was considered statistically significant. Risk of bias was assessed with Review Manager 5.4. and the Newcastle-Ottawa scale. Nineteen studies with a total of 1,182 patients met the inclusion criteria. Compared to static fixation, dynamic fixation had a significantly higher Olerud-Molander Ankle Score (OMAS) at both 1-year [standardized mean difference (SMD) =0.43; 95% confidence interval (CI): 0.22 to 0.65; P<0.05] and 2-year post-operation (SMD =0.76; 95% CI: 0.33 to 1.20; P<0.05). Dynamic fixation had a significantly lower reoperation rate than static fixation [risk ratio (RR) =0.55; 95% CI: 0.36 to 0.83; P=0.004]. Compared to static fixation, fibular nail had a significantly higher OMAS at 1-year post-operation (SMD =0.28; 95% CI: 0.03 to 0.53; P=0.03). Fibular nails had significantly lower infection (RR =0.12; 95% CI: 0.04 to 0.37; P<0.05) and reoperation rates (RR =0.22; 95% CI: 0.06 to 0.86; P=0.03) than static fixation. Compared to fibular nail, dynamic fixation had a significantly higher OMAS at both 1-year (SMD =1.07; 95% CI: 0.83 to 1.31; P<0.05) and 2-year post-operation (SMD =1.03; 95% CI: 0.60 to 1.47; P<0.05). Dynamic fixation had a significantly higher reoperation rate compared to fibular nail (RR =20.41; 95% CI: 2.81 to 148.21; P=0.003). Dynamic fixation seems to be the superior treatment method, displaying better outcomes than static fixation and fibular nailing, with the fibular nail proving to be a viable alternative. Dynamic fixation should be the first choice of treatment for those with syndesmotic ankle fractures due to its clinical advantages compared to static fixation and fibular nailing. 3.

Poststroke Seizure and Epilepsy: A Review of Incidence, Risk Factors, Diagnosis, Pathophysiology, and Pharmacological Therapies

Stroke is the most common cause of epilepsy and ultimately leads to a decrease in the quality of life of those affected. Ischemic and hemorrhagic strokes can both lead to poststroke epilepsy (PSE). Significant risk factors for PSE include age < 65age less than 65 years, stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS), cortical involvement, and genetic factors such as TRPM6 polymorphism. The diagnosis of PSE is made by using imaging modalities, blood biomarkers, and prognostic criteria. Electroencephalography (EEG) is currently the gold standard to diagnose PSE, while new combinations of modalities are being tested to increase diagnostic specificity. This literature review uncovers a newly found mechanism for the pathology of poststroke epilepsy. The pathogenesis of early-onset and late-onset is characterized by sequelae of neuronal cellular hypoxia and disruption of the blood-brain barrier, respectively. Interleukin-6 is responsible for increasing the activity of glial cells, causing gliosis and hyperexcitability of neurons. Epinephrine, high-mobility group protein B1, downregulation of CD32, and upregulation of HLA-DR impact the pathology of poststroke epilepsy by inhibiting the normal neuronal immune response. Decreased levels of neuropeptide Y, a neurotransmitter, act through multiple unique mechanisms, such as inhibiting intracellular Ca2+ accumulation and acting as an anti-inflammatory, also implemented in the worsening progression of poststroke epilepsy. Additionally, CA1 hippocampal resonant neurons that increase theta oscillation are associated with poststroke epilepsy. Hypertensive small vessel disease may also have an implication in the temporal lobe epilepsy by causing occult microinfarctions. Furthermore, this review highlights the potential use of statins as primary prophylaxis against PSE, with multiple studies demonstrating a reduction in incidence using statins alone, statins in combination with antiepileptic drugs (AEDs), and statins with aspirin. The evidence strongly suggests that the second generation AEDs are a superior treatment method for PSE. Data from numerous studies demonstrate their relative lack of significant drug interactions, increased tolerability, and potential superiority in maintaining seizure-free status.

Glycoalkaloid Solasonine Targets SHH Signaling to Block MED12 Mutant Breast Cancer Oncogenesis

As breast cancer is the second leading cause of cancer deaths among American women, there is a strong need to find improved treatment strategies for this disease. Radiation and chemotherapy are the frontline choice of treatment; however, personalized treatment is rapidly on the rise as a superior treatment method. Through prior studies, it has been found that 67% of breast cancer tumors carry a mutation in the Mediator subunit MED12 thus indicating that MED12 likely has a critical tumor suppressive role in the breast. Interestingly, previous results from our lab, and others, have indicated that MED12 plays a role in restricting GLI3‐dependent SHH signaling. This finding is of importance to this study as hyper‐activated SHH signaling is known to play a role in promoting breast cancer oncogenesis. We thus hypothesize that MED12 mutations cause breast cancer oncogenenesis through hyperactivated SHH signaling, and furthermore, that drugs which target the SHH signaling pathway could prove to be beneficial for MED12 mutant breast cancer. Through proliferation assays and quantitative PCR analysis, we were able to conclude that MED12 mutations, as mimicked by a MED12 knockdown setting, enhance breast cancer cell growth and promote GLI3‐dependent SHH signaling. Through a MTT screening strategy, we found that the natural compound Solasonine can differentially target MED12 knockdown breast cancer cells. Solasonine is a known glycoalkaloid that has previously been shown to potentially target anti‐inflammatory signaling pathways. To study the effect of Solasonine on MED12 knockdown breast cancer cells, quantitative PCR was used to measure the levels of GLI3 target genes in cells treated with either vehicle or Solasonine. We found that Solasonine treatment significantly decreased the GLI3 target genes GLI1 and CREB 5 thus suggesting that Solasonine could target the GLI3‐dependent SHH signaling pathway to block breast cancer oncogenesis. These findings were further complemented by colony formation assays which showed that Solasonine treatment leads to a significant reduction in the formation of colonies in vitro. Overall, our findings suggest that Solasonine targets the SHH signaling pathway to block breast cancer oncogenesis and may therefore prove to be a superior treatment method for MED12 mutant breast cancer.

Assessment and Modeling of Plasmonic Photothermal Therapy Delivered via a Fiberoptic Microneedle Device Ex Vivo.

Plasmonic photothermal therapy (PPTT) has potential as a superior treatment method for pancreatic cancer, a disease with high mortality partially attributable to the currently non-selective treatment options. PPTT utilizes gold nanoparticles infused into a targeted tissue volume and exposed to a specific light wavelength to induce selective hyperthermia. The current study focuses on developing this approach within an ex vivo porcine pancreas model via an innovative fiberoptic microneedle device (FMD) for co-delivering light and gold nanoparticles. The effects of laser wavelengths (808 vs. 1064 nm), irradiances (20–50 mW·mm−2), and gold nanorod (GNR) concentrations (0.1–3 nM) on tissue temperature profiles were evaluated to assess and control hyperthermic generation. The GNRs had a peak absorbance at ~800 nm. Results showed that, at 808 nm, photon absorption and subsequent heat generation within tissue without GNRs was 65% less than 1064 nm. The combination of GNRs and 808 nm resulted in a 200% higher temperature rise than the 1064 nm under similar conditions. A computational model was developed to predict the temperature shift and was validated against experimental results with a deviation of <5%. These results show promise for both a predictive model and spatially selective, tunable treatment modality for pancreatic cancer.

Clinical Case of Bilateral Mandibular Auto Transplantation for Missing Bilateral First Molars: Case Report and Review of Literature

Auto transplantation is a fast and economical option when a suitable donor tooth is available for replacement of a tooth considered impossible to treat. The purpose of this case report is to describe methods used for autotransplantation and its advantages for cases with a missing bilateral mandibular firstmolar, as compared with a dental implant, removable partial denture, and other methods of prosthesis. In the present patient who underwent auto transplantation, clinical and radiographic outcomes were considered satisfactory at one and two years postoperatively. Bone healing was observed around the roots of transplanted teeth, which showed good function. In autotransplantation cases, even when the donor tooth has complete root formation, a high success rate can be achieved when the patient is properly selected and treated. Although the chance of root resorption remains because of necrotic pulp and periodontal irritation during manipulation, auto transplantation should be considered as a good treatment modality in feasible cases. Based on the present findings, even though autotransplantation is not common in general dental practice, we consider that it offers a clinically and economically viable alternative as compared to other more complicated prosthetic and dental implant treatments. The purpose of this report is to show that auto transplantation is a superior treatment method for single molar defects as compared to other prosthetic methods, as the periodontal ligament of the patient can be used and cutting adjacent teeth is avoided. In addition, it is a treatment method that can effectively utilize a wisdom tooth.

Comparison of oropharyngeal airway dimensional changes in patients with skeletal Class II and Class III malocclusions after orthognathic surgery and functional appliance treatment: A systematic review

ObjectiveTo compare the dimensional changes in the oropharyngeal airway in patients with skeletal Class II and Class III malocclusion before and after orthognathic surgery and treatment with a functional appliance. MethodsThe protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and was registered to the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42020170901. Furthermore, the reporting of the present SR was performed based on the PRISMA checklist. ResultsThe use of removable functional appliances increased the volume of the oropharyngeal airway in patients with skeletal Class II malocclusion. Furthermore, the increase in the volume of the oropharyngeal airway following the removable functional appliance treatment was more than that observed after fixed functional appliance treatment in growing patients. For patients with skeletal Class III malocclusion, who underwent the bimaxillary orthognathic surgery, resulted in no change in the dimensions of the oropharyngeal airway. ConclusionGrowing patients who receive removable functional appliance treatment have a more favorable long-term prognosis with regard to the oropharyngeal airway when compared with those who receive fixed functional appliance. Alternatively, in patients aged from (18–22) years with skeletal class III malocclusion Bimaxillary orthognathic surgery was found to be the recomended and superior method of treatment.

Natural Compounds Can Target SHH Signaling To Block MED12 Mutant Breast Cancer Oncogenesis

Current statistics show that breast cancer is the second leading cause of cancer deaths among American women. Therefore, there is a strong need to find improved treatment strategies for women suffering from this lethal disease. Though radiation and chemotherapy have been the frontline choice of treatment for cancer over the past few decades, due to the detrimental side effects, personalized treatment is rapidly rising as a superior treatment method. This is largely due to recent advances in genome-wide DNA sequencing that have allowed for the identification of cancer-related mutational landscapes. Through these studies, it has been found that up to 67% of breast cancer tumors carry a mutation in the Mediator subunit MED12 thus indicating that MED12 likely has a critical tumor suppressive role in breast cancer. Previous results from our lab, and others, have indicated that MED12 plays a critical role in restricting GLI3-dependent SHH signaling. This finding is of particular interest to this study since hyper-activated SHH signaling is known to play a major role in promoting breast cancer oncogenesis. Due to these findings, we hypothesize that mutations in MED12 cause hyper-activated SHH signaling in breast cancer to promote oncogenesis and, furthermore, that natural compounds could provide useful as a personalized treatment for MED12 mutant breast cancer. To study the effect of mutant MED12, a lentivirus carrying an shRNA against MED12 was generated and infected into MCF-7 cells. Since the vast majority of breast cancer-associated MED12 mutations lead to loss of protein function, the knockdown strategy through lentiviral shRNA is assumed to mimic the MED12 mutant setting. Proliferation assays were utilized to confirm that downregulated MED12 plays a role in the increased proliferation of breast cancer cells. Next, quantitative PCR was performed to determine the effect of downregulated MED12 on the expression of genes that are known to be regulated by GLI3. Finally, a screening strategy was employed by using a natural compound library to find potential novel treatment strategies for MED12 mutant breast cancer. Our findings confirmed that downregulation of MED12 increases proliferation of breast cancer cells in vitro thereby providing a strong argument that mutant MED12 would have the same effect. Through quantitative PCR it was confirmed that GLI3 target genes are upregulated in cancer cells when MED12 expression is low. Importantly, our natural compound screen identified several novel therapeutic compounds that specifically target MED12 downregulated breast cancer cells through a mechanism that involves SHH signaling. We therefore uncovered that MED12 mutations promote GLI3-dependent SHH signaling in breast cancer and, importantly, we identified potential novel therapeutic strategies for MED12 mutant breast cancer patients.

Interventions for Distal Radius Fractures: A Meta-analysis of Comparison Studies.

Background Distal radius fractures are one of the most frequent orthopaedic injuries. There are many effective treatment methods, such as volar plate, dorsal plate, percutaneous pins, external fixation, and casting; however, comparison of the treatment outcomes has not been thoroughly investigated. Our purpose is to determine if volar plating is the superior treatment method for distal radius fractures. We will address this through the following questions: First, is volar plating superior to dorsal plating, percutaneous pins, external fixation, or casting in terms of reported complications? Second, does volar plating produce superior functional outcomes to dorsal plating, percutaneous pins, external fixation, or casting? Third, are the radiographic outcomes superior for volar plating when compared with dorsal plating, percutaneous pins, external fixation, or casting? Methods MEDLINE, Academic Search Ultimate, Academic Search Complete, CINAHL Plus, and JSTOR databases, as well as manual search, were used to identify papers comparing complications and functional results of volar plating to other treatment methods for distal radius fractures published after the year 2000. Complication data and function scores were recorded. Risk of bias was assessed using the Cochrane Risk of Bias Tool and data was analyzed for meta-analysis using Cochrane ReviewManager software. Results Compared with dorsal plate, volar plate performed significantly better in Gartland and Werley score. Volar plating outperformed percutaneous pins for loss of reduction, infection, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and ulnar deviation. Loss of reduction, malunion, Patient Related Wrist Evaluation (PRWE) score, DASH score, grip strength, ulnar deviation, and supination were significantly better for volar plating when compared with casting. When compared with external fixation, volar plating had significantly less cases of infection, lower QuickDASH score, and higher range of motion for flexion, pronation, and supination. All other complication and functional outcomes were not significantly different. Conclusions Distal radius fractures treated with volar plating showed relatively better measures of complications, function scores, and range of motion than other treatment methods; however, there was no significant difference in healing time when compared with percutaneous pins. More studies are needed to compare the rest of the treatment methods with each other.

Functional and radiological outcome of unstable lower end radius fracture treated with percutaneous kirschner wires and cast in adults

Background: Fracture of lower end of radius is common fracture in orthopaedic practice. No age is immune to this fracture but commonly seen in elderly population. Till date there is no consensus in management of this fracture. Variety of treatment is available in literature from casting to plating of this fracture. Minimal invasive technique of percutaneous k-wire fixation and cast is cost-effective with better functional end results.Material and method: In this study, Frykman`s classification system has been used to describe the fracture types. Frykman type II and IV were more common fracture pattern. All patients were treated with percutaneous multiple k wires and cast. Cast and k- wires were removed after six weeks. Results: In this study thirty patients were treated by this technique. results were analysed according to Lindstrom`s criteria for anatomical and functional end results. All patients had good to excellent functional results. Discussion: Though this fracture is described sssince so many years, unsatisfactory results are also common. Percutaneous pinning is attempted to bridge the gap between conservative and more invasive procedures. This fracture is commonly seen in elderly population. Co-morbid medical conditions are highly present in these people. So any invasive procedure is not without any risk. This minimal invasive procedure is gold standard in these age groups. In this study most of the patient had good functional end results. Conclusion: Minimal invasive percutaneous Kirshner wire fixation is superior method of treatment for distal end radius fractures. There is very low incidence of complication and unsatisfactory results.

MED12 Mutations Play a Pivotal Role in Breast Cancer Oncogenesis

There is a critical need for superior breast cancer treatment since this disease remains the second leading cause of cancer deaths among American women. Though radiation and chemotherapy have been the frontline choice of treatment for cancer over the past few decades, due to the detrimental side effects, personalized treatment is rapidly rising as a superior treatment method. This is largely due to recent advances in genome‐wide DNA sequencing that have allowed for the identification of cancer‐related mutational landscapes. Through these technologies, MED12, a subunit of Mediator protein, has been found to be commonly mutated in a significant number of breast cancer patients. Therefore, uncovering the mechanistic basis behind MED12 mutant breast cancer is critical in order to find a personalized treatment regimen for this subclass of breast cancer. Previous work has shown that MED12 restricts GLI3‐dependent Sonic Hedgehog (SHH) signaling, a pathway that is often hyper activated in advanced breast cancer. We therefore hypothesize that mutated MED12 promotes GLI3‐dependent SHH signaling in breast cancer cells thereby promoting tumorigenesis and that this signaling pathway could be an effective therapeutic target in MED12 mutant breast cancer. To study the effect of mutant MED12, a lentivirus carrying an shRNA against MED12 was generated and infected into MCF‐7 cells. Since the vast majority of breast cancer‐associated MED12 mutations lead to loss of protein function, the knockdown strategy through lentiviral shRNA is assumed to mimic the MED12 mutant setting. Proliferation assays were utilized to confirm that downregulated MED12 plays a role in the increased proliferation of breast cancer cells. Next, quantitative PCR was performed to determine the effect of downregulated MED12 on the expression of genes that are known to be regulated by GLI3. Finally, a screening strategy was employed by using a natural compound library to find potential novel treatment strategies for MED12 mutant breast cancer. Our findings confirmed that downregulation of MED12 increases proliferation of breast cancer cells in vitro thereby providing a strong argument that mutant MED12 would have the same effect. Through quantitative PCR it was confirmed that GLI3 target genes are upregulated in cancer cells when MED12 expression is low. Importantly, our natural compound screen identified several novel therapeutic compounds that specifically target MED12 downregulated breast cancer cells through a mechanism that involves SHH signaling. We therefore uncovered that MED12 mutations promote GLI3‐dependent SHH signaling in breast cancer and we identified potential novel therapeutic strategies for MED12 mutant breast cancer patients.

There is no superior treatment method for medial shoulder instability in dogs

PICO question&#x0D; In dogs with medial shoulder instability, what treatment option results in the best patient outcomes medical vs. surgical management?&#x0D; Clinical bottom line&#x0D; To date only one retrospective case series is available to compare treatment options for shoudler instability. This manuscript suggests that surgical treatment of medial shoulder instability (MSI) may be superior to medical management, however, this was not a prospective randomly assigned study and thus is wrought with limitations. There is no evidence of superiority of one surgical intervention over another for the treatment of MSI. The clinician must evaluate each individual case and consider clincial experience when deciding on the ideal treatment for MSI.&#x0D; How to apply this evidence in practice&#x0D; The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.&#x0D; Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care. &#x0D; &#x0D;

An Evidence-Based Approach to Casting and Orthosis Management of the Pediatric, Adolescent, and Young Adult Population for Injuries of the Upper Extremity: A Review Article.

Review the use of upper-extremity orthoses and casts after injuries to the wrist and hand in the pediatric, adolescent, and young adult population. The common injuries reviewed include pediatric distal radius fractures, scaphoid fractures, metacarpal fractures, mallet fingers, volar plate injuries of the proximal interphalangeal (PIP) joint, and ulnar collateral ligament (UCL) tears of the thumb metacarpophalangeal (MCP) joint. We conducted a literature review from 1985 to 2016 of upper-extremity orthotic interventions. Non-English language citations and animal studies were excluded. Citations from retrieved studies were used to identify other relevant publications. This review included cases of common injuries to the upper extremity, which required orthotic intervention. Immobilization recommendations for nonsurgical pediatric distal radius fractures, nonsurgical metacarpal fractures, mallet fingers, and UCL tears of the thumb MCP include a removable orthosis. Nondisplaced scaphoid fracture orthosis recommendations include initial immobilization in a nonremovable short-arm thumb spica cast. Volar plate injuries of the PIP joint require buddy straps for healing. The literature demonstrates the effectiveness of removable orthoses in healing, patient satisfaction, and time to return to activity after many common upper-extremity injuries. Removable orthoses should be considered an equal or superior treatment method to cast immobilization, immobilization of additional joints, or longer periods of immobilization.

Surgical outcomes of laparoscopic adrenalectomy for primary hyperaldosteronism: 20 years of experience in a single institution.

PurposeRecently, posterior retroperitoneoscopic adrenalectomy (PRA) has been reported to have some advantages over laparoscopic transperitoneal adrenalectomy (LTA). The objectives of this study were to report our experience over 12 years with laparoscopic adrenalectomy for primary hyperaldosteronism (PHA) and to examine surgical outcomes of PRA compared with LTA in patients with PHA.MethodsThe medical records of 527 patients who underwent minimally invasive adrenalectomy, including LTA or PRA, from January 2006 until May 2017 were reviewed at Severance Hospital (Seoul, Korea). Clinicopathologic characteristics and surgical outcomes of 146 patients with PHA who underwent LTA (19 patients) or PRA (127 patients) were analyzed retrospectively by complete chart review.ResultsThe overall rates of biochemical and clinical cure were 91.1% and 93.1%, respectively. The mean operation time of the PRA group was significantly shorter than that of the LTA group (72.3 ± 24.1 minutes vs. 115.7 ± 69.7 minutes, P = 0.015). The length of hospital stay in the PRA group was significantly shorter than in the LTA group (3.5 ± 1.3 days vs. 4.2 ± 1.6 days, P = 0.029), and the first meal after surgery came earlier in the PRA group (0.3 ± 0.5 days vs. 0.6 ± 0.5 days, P = 0.049). The number of pain-killers used was also significantly smaller in the PRA group (2.3 ± 2.1 vs. 4.3 ± 2.3, P < 0.001).ConclusionPRA offers an alternative or likely superior method for treatment of small adrenal diseases such as PHA, with improved surgical outcomes.

Does external fixation result in superior ankle function than open reduction internal fixation in the management of adult distal tibial plafond fractures?

Traditionally distal tibial plafond fractures were managed with open reduction internal fixation however, high complication rates have prompted the use of external fixation as an alternative. No definitive review has been conducted and the issue of superior treatment method remains contentious. This review assesses the comparative effectiveness of both with regards ankle function. A search strategy was formulated with keywords ensuring full use of Medical Subject Headings terms for maximum sensitivity with Boolean combinations. Multiple databases were used. All papers had limitations, hence results and conclusions must be considered conservatively. Paper-1 demonstrated an association between ORIF and superior ankle function (P<0.05). Papers-2 and -3 demonstrated no significant difference (P>0.05) between treatment techniques. Neither method can yet be widely advocated as superior with the treatment method chosen remaining primarily on surgeon preference and experience. This review highlights the requirement for further, high-quality research in this area.

Successful Kidney Transplantation in Patient on Hemodialysis and Intellectual Inferiority

Abstract Introduction. Kidney transplantation from a living donor is a superior method for treatment of end-stage renal disease (ESRD). The aim of this report is to show that the intellectual inferiority should not be an obstacle for the success of this treatment modality. Case report. We present a 25-year-old female patient with physical and intellectual impairment, with focal-segmental glomerulonephritis diagnosed in 2006 as primary cause of ESRD, regularly followed up at the Department of nephrology. She was initiated on hemodialysis (HD) since July 2014. Although with a bad compliance and hypertension, a good dialysis adequacy was managed with a reduction of the extracellular volume (ECV) and kidney transplantation was indicated as a more convenient treatment option. With psychological assessment of the intellectual inferiority being not contraindication for kidney transplantation and highly motivated family she was transplanted in March 2015. Postoperatively, she was with prolonged hospitalization because of the delayed graft recovery and a couple of perioperative urinary and surgical site infections. In the following months she was slowly adapting to a regular hygienic and diet regimen and intake of medication, with a number of consultations at the Department along with the family. At present, the patient has an excellent health condition and significantly better quality of life. Conclusion. The physical handicap of a moderate degree and mild intellectual impairment are not a contraiidication for treatment of the terminal kidney disease. A successful kidney transplantation reduces the morbidity and mortality from the primary disease, and improve patient’s overall quality of life.

Distal Radius Fracture: Hep Versus Supervised Therapy: A Systematic Review

Purpose: A systematic review of the literature was performed to evaluate post operative management of distal radius fractures and more specifically to evaluate studies which investigate instruction with a homeexercise programversus a formalized therapy program. Background: The current evidence is insufficient for determining best rehabilitative management for patient’s following a distal radius fracture. The appropriate rehabilitation and treatment following a distal radius fracture can help individuals regain function and prevent long standing disability. Further investigation and study into the current evidence may add to our existing knowledge base for developing a best treatment practice for the diagnosis of distal radius fracture. Methods: A PubMed and PEDro search using terms: wrist fracture AND supervised therapy, occupational therapy AND wrist fracture, physical therapy AND wrist fracture, wrist fracture AND orthosis, distal radius fracture AND exercise, and distal radius fracture AND home program. 383 papers were identified. Duplicates were removed, titles and abstracts were reviewed and 20 potential papers remained. Studies that met the inclusion criteria were evaluated for research quality using The Structured Effectiveness for Quality Evaluation of Study (SEQES). Results: 8 trials met the inclusion criteria involving 474 participants with a distal radius fracture. The trials included in the study had various co-interventions and lacked uniformity regarding duration, frequency, and administration of interventions. Two of the trials supervised physical therapy more efficacious than instruction alone. One trial found physician instruction superior to physiotherapy for improved patient function. Five of the trials found no difference between therapy and home instruction. Conclusion: The available evidence from randomized controlled trails is insufficient to support a home exercise program or a structured occupational or physical therapy program as a superior method of treatment for adults following a distal radius fracture with volar plating.

Ectopic Bone Formation after Medial Femoral Condyle Graft to Scaphoid Nonunion

Free vascularized bone graft from the medial femoral condyle has been described as a superior method for treatment of recalcitrant scaphoid nonunion with proximal pole avascularity and humpback deformity. Few complications and high union rates have been reported. In a series of three patients we describe an undesired volar ossification as a potential complication of the method. The risk of developing the ectopic bone formation can be minimized if the surgeon is aware of the strong osteogenic capacity of the periosteum. Meticulous dissection of the vascular bundle to the graft is mandatory to avoid the complication. Caution is warranted so as not to leave a periosteal sleeve under the vessels at the margin of the graft.

Therapist supervised clinic-based therapy versus instruction in a home program following distal radius fracture: A systematic review

PurposeThe primary purpose of this systematic review is to determine the effectiveness of a home program or a structured therapy program for patients following distal radius fracture. MethodsA search was performed using terms wrist fracture, supervised therapy, occupational therapy, physical therapy, splint, orthosis, distal radius fracture, exercise, and home program. Studies that met the inclusion criteria were evaluated for research quality using The Structured Effectiveness for Quality Evaluation of Study (SEQES). ResultsFive of the seven trials found no difference between outcomes for their subjects that had uncomplicated distal radius fractures. The population that has complications following distal radius fractures was not represented in the studies reviewed. ConclusionThe available evidence from randomized controlled trials is insufficient to support a home program or therapist supervised clinic-based program as a superior method of treatment for adults following a distal radius fracture without complications or the presence of comorbidities.

Primary hip spica with crossed retrograde intramedullary rush pins for the management of diaphyseal femur fractures in children: A prospective, randomized study.

Background:Femoral fractures are common in children aged between 2 and 12 yearsand 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as a conservative treatment. We compared primary hip spica or traction followed by hip spica with closed reduction and fixation with retrogradely passed crossed Rush pins for diaphyseal femur fracture in 25 children of the age group 3-12 years, randomly distributed in each group.Materials and Methods:Fifty children (age: 3-13 years, mean; 9 years) with femoral fractures were evaluated; 25 of them underwent the conservative treatment using immediate hip spica (group A) and 25 underwent treatment with crossed retrograde Rush pins (group B).Results:Mean duration of fracture union was within 15 weeks in group A and 12 weeks in group B. Mean duration of weight bearing was 14weeks in group A and 7 weeks in group A. Mean hospital stay were 4 days in group A and 8days in group B. The man follow-up period was 16 months in group A and 17 months in group B. Complications like angulation, shortening and infection were compared. Bursitis and penetration of pins at the site of Rush pin insertion is a complication associated with this method of treatment.Conclusion:Closed reduction and internal fixation with crossed Rush pins was a superior treatment method in terms of early weight bearing and restoration of normal anatomy.