Surgical Treatment Of Patients Research Articles

Disparity in sex in ankle fracture treatment

BackgroundLiterature has shown implicit bias in the treatment between non-operative and surgical treatment in patients with certain types of ankle fractures, which comprise 7.6% of all adult fractures. An understanding of any bias across all ankle fracture management may prove to be critical for the understanding of potential correlations between treatment methods and outcomes of patients with ankle fractures. Therefore, this study aimed to determine whether there is a sex-based bias in the operative and non-operative treatment of all ankle fractures. MethodsA retrospective study of 1175 adult patients with ankle fractures was conducted. Data extracted included sex, race, age, type of treatment (non-operative/operative), fracture type (displaced/non-displaced), fracture class, BMI, and length of hospital stay. Odds ratio (OR), Chi-squared, t-test, and Pearson’s correlation tests were used with p < 0.05 considered significant. ResultsThe study population consisted of 750 females (63.8%) and 425 males (36.2%). The study demonstrated a sex-based disparity in operative and non-operative treatment revealing that women are less likely than men to receive operative treatment for displaced ankle fractures (OR = 0.7, 95% CI: 0.5–0.9, p = 0.01). Of the 750 females, 417 (55.6%) underwent non-operative treatment, while 333 (44.4%) females had an operation. Of the 425 males, 204 (48%) had non-operative treatment, while 221 (52%) underwent operative treatment. The distribution of ankle fracture classes between both sexes was similar, suggesting fracture class did not influence the observed disparity. ConclusionOur results suggest sex correlates with the treatment type for ankle fractures, with women more likely to receive non-operative treatment for displaced fractures. As post-treatment outcomes often reflect the chosen form of treatment, it is imperative to determine if a disparity in sex explicates differences in clinical outcomes.

Utility of interventional endoscopic ultrasound in pancreatic cancer.

Endoscopic ultrasound (EUS) has an important role in the management algorithm of patients with pancreatic ductal adenocarcinoma (PDAC), typically for its diagnostic utilities. The past two decades have seen a rapid expansion of the therapeutic capabilities of EUS. Interventional EUS is now one of the more exciting developments within the field of endoscopy. The local effects of PDAC tend to be in anatomical areas which are difficult to target and endoscopy has cemented itself as a key role in managing the clinical sequelae of PDAC. Interventional EUS is increasingly utilized in situations whereby conventional endoscopy is either impossible to perform or unsuccessful. It also adds a different dimension to the host of oncological and surgical treatments for patients with PDAC. In this review, we aim to summarize the various ways in which interventional EUS could benefit patients with PDAC and aim to provide a balanced commentary on the current evidence of interventional EUS in the literature.

Treatment of Iatrogenic Nerve Injury After Humeral Shaft Fracture Fixation: A Case Report

Background. Iatrogenic neuropathies of the radial nerve following intramedullary nailing of the humerus are observed in 2.9% of patients. In 30% of cases, iatrogenic nerve injury is associated with distal nail locking. Questions about the timing and volume of diagnostic measures to determine the nature of nerve damage, methods of conservative and surgical treatment, and their effectiveness remain relevant.&#x0D; Aim of the study to illustrate the causes, prevention methods, diagnosis, and treatment of iatrogenic radial nerve injuries in humeral shaft fractures through a clinical example.&#x0D; Case presentation. A 30-year-old female patient was admitted with a nonunion fracture of the left humerus and iatrogenic radial nerve injury three months after the fracture was fixed with a locking nail. A revision operation was performed: removal of the nail from the left humerus; re-fixation of the left humerus with a plate; revision, neurolysis, and plastic repair of the left radial nerve using autografts from the right sural nerve. Postoperative courses of medication therapy, physiotherapy, and therapeutic exercises were conducted. At 26 months after the surgery, complete range of motion and restoration of strength in active extension of the left wrist and three phalanges, abduction of the first finger, partial extension of the first finger, and restoration of sensitivity on the outer surface of the left forearm and the back of the hand were observed.&#x0D; Conclusion. Iatrogenic radial nerve injury primarily occurs as a result of incorrect technique when introducing locking screws during intramedullary nailing of humeral shaft fractures. Delayed examination and surgical treatment of patients with injured radial nerve lead to a lack of full functional recovery, potential muscle atrophy, and impairment of their motor function. Surgical treatment aimed at restoring the radial nerve at an early stage after injury, combined with a full range of postoperative rehabilitation for a year, is the only correct treatment approach.

Capabilities of delayed microsurgical reconstruction in patients with squamous cell carcinoma of the buccal mucosa: clinical case

Surgical treatment of patients with locally advanced squamous cell carcinoma of the oral mucosa is a complicated problem requiring maximal surgical radicality and, at the same time, single-stage reconstruction to preserve organ function and achieve acceptable esthetic results. One of modern reconstruction techniques is the use of free flaps. Application of this technique requires microsurgical skills from the surgeon. unfortunately, it is not always possible to achieve the result after single-stage postoperative defect closure. Sometimes unforeseen complications are observed: necrosis of the moved flaps, formation of large postoperative defects, orostomas, pharyngostomas. In such cases, oncologists face a more complicated problem: defect reconstruction in the conditions of pronounced scarring process in the intervention area, development of post-radiation fibrosis and soft tissue edema.The presented clinical case demonstrates the capabilities of repeat microsurgical reconstruction in patients with orostoma developed after unsuccessful primary reconstruction.

Effect of Peritalar Subluxation Correction for Progressive Collapsing Foot Deformity on Patient-Reported Outcomes.

Peritalar subluxation (PTS) is part of progressive collapsing foot deformity (PCFD). This study aimed to evaluate initial deformity correction and PTS optimization in PCFD patients with flexible hindfoot deformity undergoing hindfoot joint-sparing surgical procedures and its relationship with improvements in patient-reported outcome measures (PROMs) at latest follow-up. We hypothesized that significant deformity/PTS correction would be observed postoperatively, positively correlating with improved PROMs. A prospective comparative study was performed with 26 flexible PCFD patients undergoing hindfoot joint-sparing reconstructive procedures, mean age 47.1 years (range, 18-77). We assessed weightbearing computed tomography (WBCT) overall deformity (foot and ankle offset [FAO]) and PTS markers (distance and coverage maps) at 3 months, as well as PROMs at final follow-up. A multivariate regression model assessed the influence of initial deformity correction and PTS optimization in patient-reported outcomes. Mean follow-up was 19.9 months (6-39), and the average number of procedures performed was 4.8 (2-8). FAO improved from 9.4% (8.4-10.9) to 1.9% (1.1-3.6) postoperatively (P < .0001). Mean coverage improved by 69.6% (P = .012), 12.1% (P = .0343) and 5.2% (P = .0074) in, respectively, the anterior, middle, and posterior facets, whereas the sinus tarsi coverage decreased by an average 57.1% (P < .0001) postoperatively. Improvements in patient-reported outcomes were noted for all scores assessed (P < .03). The multivariate regression analysis demonstrated that improvement in both FAO and PTS measurements significantly influenced the assessed PROMs. This study demonstrated significant improvements in the overall 3D deformity, PTS markers, and PROMs following hindfoot joint-sparing surgical treatment in patients with flexible PCFD. More importantly, initial 3D deformity correction and improvement in subtalar joint coverage and extraarticular impingement have been shown to influence PROMs significantly and positively. Addressing these variables should be considered as goals when treating PCFD. Level II, prospective cohort study.

Surgical treatment of aortic root abscess: 10-year single center experience

The issue of optimal surgical scope in patients with aortic root abscess due to infective endocarditis remains open, since there are different strategies and interventional methods. In addition, the guidelines do not give preference to any particular type of surgical intervention and recommend an individual approach to each situation. The study included 25 patients with aortic root abscess due to aortic valve infective endocarditis. The most frequently performed surgical intervention in patients was the Ross procedure (n=12, 48%). Eight (32%) patients of the center underwent aortic homograft root replacement. Combined surgery was performed in 7 (28%) patients as follows: 3 (12%) patients — interventions on the mitral valve (all patients underwent mitral valve repair due to mitral valve involvement in abscess), 3 (12%) — coronary artery bypass grafting, 1 (4%) — ascending aortic replacement due to dilatation. Five- and ten-year survival after surgical treatment of patients with aortic root abscess was 86,9% and 78,6%, respectively. There was no reintervention and recurrence of infective endocarditis in the long-term period.

Surgical treatment of aortic root abscess: 10-year single center experience

The issue of optimal surgical scope in patients with aortic root abscess due to infective endocarditis remains open, since there are different strategies and interventional methods. In addition, the guidelines do not give preference to any particular type of surgical intervention and recommend an individual approach to each situation. The study included 25 patients with aortic root abscess due to aortic valve infective endocarditis. The most frequently performed surgical intervention in patients was the Ross procedure (n=12, 48%). Eight (32%) patients of the center underwent aortic homograft root replacement. Combined surgery was performed in 7 (28%) patients as follows: 3 (12%) patients — interventions on the mitral valve (all patients underwent mitral valve repair due to mitral valve involvement in abscess), 3 (12%) — coronary artery bypass grafting, 1 (4%) — ascending aortic replacement due to dilatation. Five- and ten-year survival after surgical treatment of patients with aortic root abscess was 86,9% and 78,6%, respectively. There was no reintervention and recurrence of infective endocarditis in the long-term period.

Conventional versus hypofractionated postmastectomy proton radiotherapy in the USA (MC1631): a randomised phase 2 trial

Proton therapy is under investigation in breast cancer as a strategy to reduce radiation exposure to the heart and lungs. So far, studies investigating proton postmastectomy radiotherapy (PMRT) have used conventional fractionation over 25-28 days, but whether hypofractionated proton PMRT is feasible is unclear. We aimed to compare conventional fractionation and hypofractionation in patients with indications for PMRT, including those with immediate breast reconstruction. We did a randomised phase 2 trial (MC1631) at Mayo Clinic in Rochester (MN, USA) and Mayo Clinic in Arizona (Phoenix, AZ, USA) comparing conventional fractionated (50 Gy in 25 fractions of 2 Gy [relative biological effectiveness of 1·1]) and hypofractionated (40·05 Gy in 15 fractions of 2·67 Gy [relative biological effectiveness of 1·1]) proton PMRT. All patients were treated with pencil-beam scanning. Eligibility criteria included age 18 years or older, an Eastern Cooperative Oncology Group performance status of 0-2, and breast cancer resected by mastectomy with or without immediate reconstruction with indications for PMRT. Patients were randomly assigned (1:1) to either conventional fractionation or hypofractionation, with presence of immediate reconstruction (yes vs no) as a stratification factor, using a biased-coin minimisation algorithm. Any patient who received at least one fraction of protocol treatment was evaluable for the primary endpoint and safety analyses. The primary endpoint was 24-month complication rate from the date of first radiotherapy, defined as grade 3 or worse adverse events occurring from 90 days after last radiotherapy or unplanned surgical interventions in patients with immediate reconstruction. The inferiority of hypofractionation would not be ruled out if the upper bound of the one-sided 95% CI for the difference in 24-month complication rate between the two groups was greater than 10%. This trial is registered with ClinicalTrials.gov, NCT02783690, and is closed to accrual. Between June 2, 2016, and Aug 23, 2018, 88 patients were randomly assigned (44 to each group), of whom 82 received protocol treatment (41 in the conventional fractionation group and 41 in the hypofractionation group; median age of 52 years [IQR 44-64], 79 [96%] patients were White, two [2%] were Black or African American, one [1%] was Asian, and 79 [96%] were not of Hispanic ethnicity). As of data cutoff (Jan 30, 2023), the median follow-up was 39·3 months (IQR 37·5-61·2). The median mean heart dose was 0·54 Gy (IQR 0·30-0·72) for the conventional fractionation group and 0·49 Gy (0·25-0·64) for the hypofractionation group. Within 24 months of first radiotherapy, 14 protocol-defined complications occurred in six (15%) patients in the conventional fractionation group and in eight (20%) patients in the hypofractionation group (absolute difference 4·9% [one-sided 95% CI 18·5], p=0·27). The complications in the conventionally fractionated group were contracture (five [12%] of 41 patients]) and fat necrosis (one [2%] patient) requiring surgical intervention. All eight protocol-defined complications in the hypofractionation group were due to infections, three of which were acute infections that required surgical intervention, and five were late infections, four of which required surgical intervention. All 14 complications were in patients with immediate expander or implant-based reconstruction. After a median follow-up of 39·3 months, non-inferiority of the hypofractionation group could not be established. However, given similar tolerability, hypofractionated proton PMRT appears to be worthy of further study in patients with and without immediate reconstruction. The Department of Radiation Oncology, Mayo Clinic, Rochester, MN, the Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA, and the US National Cancer Institute.

Impact assessment of uterine artery embolization on reproductive

Introduction. Uterine artery embolization (UAE) is an effective minimally invasive manipulation that has been widely applied in obstetric and gynecological practice. The expediency of using this method of surgical treatment in patients with reproductive plans is still controversial. The main clinicians' concerns are the risk of developing local endometrial ischemia able to lead to habitual miscarriage, premature birth and pathological placentation as well as decreased ovarian reserve due to impaired adequate ovarian blood supply.Aim: to analyze the literature data regarding UAE effect on reproductive function.Materials and Methods. The search for literature was carried out in databases Web of Science, eLibrary, Scopus, PubMed/MEDLINE. We selected articles for the years 1995–2023 devoted to assessing UAE influence on reproductive function. The articles were searched by the keywords "embolization", "uterine arteries", "reproductive function", "prognosis", "assessment". No methodological filter was used to exclude the omission of suitable articles. The study included full-text sources and literary reviews on the subject under study. Articles that are not directly related to the subject UAE were excluded from the review. In order to avoid the inclusion of duplicate publications if two same author studies were found, the study period of each author was assessed, and if publication dates coincided, the most recent publication was selected.Results. Based on the review of domestic and foreign literature sources over recent years, it can be concluded that there are restrictions on the frequency and outcomes of pregnancy in such cohort of patients who underwent UAE. Many patients included in existing studies and case reports have variable factors complicating direct analysis or comparison such as age of patients, previous spontaneous abortions, previous uterine surgery, different techniques and professional training of X-ray endovascular surgeons, uncertainty of a woman regarding further reproductive plans and other forms of infertility, which can also distort research results. In addition, the most well-controlled studies often have small patients sample sizes not allowing to obtain meaningful clinical information from thereof.Conclusion. Pregnancy is possible in women after UAE, and many of these pregnancies proceed without complications and lead to successful childbirth. The actual fertility rate after UAE remains uncertain, but is approaching 38.3 % based on the available published results.

Comparing the Effectiveness of Laser Therapy, Medicaments and Surgical Treatment in Patients with Angle Closed Glaucoma

Abstract The study goal was to compare the efficiency of the medicaments, laser and surgical treatment in the patients with primary angle closure glaucoma (PACG) in order to achieve: normalization of intraocular pressure (IOP), maintaining the useful visual acuity and stabilization of visual field loss. All patients were treated at Clinic of Ophthalmology of Clinical Centre Kragujevac in Kragujevac, Serbia, in the period from June 15, 2010 to June 15, 2014. There were 116 patients in this study. They diagnosed with PACG, and they had been adequate selected for this study. They were treated with: medicaments; Nd:YAG (Neodymium:Yittrium Aluminum Garnet) laser iridotomy, and glaucoma surgery. Clinical ophthalmology controls have been introduced once or twice a month, and the vision field loss was tested three times every year. During the monitoring period of one year: no statistically significant difference occurred in terms of changes of the visual acuity among the three study-groups. The best IOP regulation was achieved after the laser treatment (53.4%), followed by the surgical treatment (28.5%), while the weakest was recorded in patients treated with the medicaments (18.1%). The percentage of the visual field loss was the biggest of patients treated with the medicaments (57%), and then the patients treated with the laser iridotomy (35%), while the least one occurred of the patients with the surgical treatment (23%). In the laser-treated group of 62 patients, the frequency of complications was 17.8%; while the out of 33 patients who had been treated (surgical), the frequency of complications was 19%. Laser iridotomy was shown to be effective of 89.5% of study-patients with PACG, while non-reactive studypatients underwent to the trabeculectomy. In addition to the high efficacy of Nd:YAG laser iridotomy in regulating of IOP values of the patients with PACG, the advantage of laser-method was in: the maneuvering of outpatients, it was easy to do, had a short lead time and was used in local anesthesia.

Peri-operative tobacco cessation interventions: a systematic review and meta-analysis.

Tobacco smoking is associated with a substantially increased risk of postoperative complications. The peri-operative period offers a unique opportunity to support patients to stop tobacco smoking, avoid complications and improve long-term health. This systematic review provides an up-to-date summary of the evidence for tobacco cessation interventions in surgical patients. We conducted a systematic search of randomised controlled trials of tobacco cessation interventions in the peri-operative period. Quantitative synthesis of the abstinence outcomes data was by random-effects meta-analysis. The primary outcome of the meta-analysis was abstinence at the time of surgery, and the secondary outcome was abstinence at 12 months. Thirty-eight studies are included in the review (7310 randomised participants) and 26 studies are included in the meta-analysis (5969 randomised participants). Studies were pooled for subgroup analysis in two ways: by the timing of intervention delivery within the peri-operative period and by the intensity of the intervention protocol. We judged the quality of evidence as moderate, reflecting the degree of heterogeneity and the high risk of bias. Overall, peri-operative tobacco cessation interventions increased successful abstinence both at the time of surgery, risk ratio (95%CI) 1.48 (1.20-1.83), number needed to treat 7; and 12 months after surgery, risk ratio (95%CI) 1.62 (1.29-2.03), number needed to treat 9. More work is needed to inform the design and optimal delivery of interventions that are acceptable to patients and that can be incorporated into contemporary elective and urgent surgical pathways. Future trials should use standardised outcome measures.

Epidemiological and Clinical Characteristics of Young Patients With Breast Cancer in Brazil: A Retrospective Study

PURPOSE Understanding the epidemiological profile of young patients with breast cancer (BC) is crucial for devising effective control strategies. However, data on Brazilian patients with BC, particularly concerning the association with pathogenic germline mutations, are limited. This retrospective cross-sectional study seeks to shed light on the epidemiological and genetic profiles of young patients with BC in Brazil, with a specific focus on the correlation between germline mutations and clinical outcomes. METHODS We analyzed medical records from two institutions in Minas Gerais, Brazil, focusing on young patients with BC diagnosed from January 2012 to December 2020. The collected variables included sociodemographic profile, tumor characteristics, mutational status, follow-up duration, and time from diagnosis to death. RESULTS The findings highlight high rates of genetic mutations, more aggressive tumor characteristics, and the necessity for more radical surgical interventions in patients with mutations. CONCLUSION In general, young patients with BC in Brazil present an unfavorable prognosis, emphasizing the need for early diagnosis and personalized treatment strategies.

Trends in the treatment of proximal humerus fractures from 2010 to 2020

The purpose of this study is to examine and compare trends in the treatment of proximal humerus fractures (PHF) (nonoperative versus operative; different surgical treatments) across different age groups over the last decade (2010-2020). The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried using ICD and CPT codes to identify all patients presenting with or undergoing surgery for PHF between 2010-2020. Treatment trends, demographics, and insurance information was analyzed during the study period. Comparisons were made between operative and nonoperative trends with respect to the number and type of surgeries performed amongst three age groups: <49 years, 50-65 years, and >65 years. The rate of postoperative complications and reoperations was evaluated and compared among different surgical treatments for patients with a minimum one-year postoperative follow-up. A total of 92,308 patients were included with a mean age of 67.8 +/- 16.8 years. Over the last decade, there was no significant increase in the percentage of PHFs treated with surgery. A total of 15,523 PHFs (16.82%) were treated operatively and these patients, compared to the nonoperative cohort, were younger (64.9 years versus 68.4 years, p<0.001), more likely to be white (80.2% versus 74.7%, p<0.001), and more likely to have private insurance (41.4% versus 32.0%, p<0.001). For patients <49 years old, trends in operative treatment have remained stable with internal fixation (IF) as the most utilized surgical modality. For patients 50-64 years old we observed a gradual decline in the utilization of hemiarthroplasty (HA), with a corresponding increase in utilization of reverse total shoulder arthroplasty (rTSA) but IF continued to be the most utilized operative modality. In patients over 65, a steep decline in the use of IF and HA was noted during the first half of the decade along with a significant exponential increase in the utilization of rTSA, which surpassed the use of IF in 2019. Despite the increase in utilization of rTSA no differences in rate of surgical complications were noted between rTSA and IF (χ2=0.245, p=0.621) or reoperations (χ2 =0.112, p=0.730). Nonsurgical treatment remains the mainstay treatment of PHFs. Although there is no increase in prevalence of operative treatment in patients >50 years in the last decade, there is an exponential increase in the utilization of rTSA with a corresponding decrease in HA and IF, a trend more substantial in patients >65 years compared to patients between 50-64 years.

The Value of Immature Granulocyte and Immature Granulocyte/Total Granulocyte Ratio in Predicting the Need for Surgical Treatment in Patients Diagnosed with Intestinal Ileus in the Emergency Department

Background/Aims: Although many biomarkers that can predict the need for surgical treatment of patients with intestinal ileus have been investigated, effective, inexpensive, and fast-resulting biomarkers have not been determined. In our study, showing the value of immature granulocyte (IG) and immature granulocyte/total granulocyte (IG/TG) ratio in predicting the need for surgical treatment in patients diagnosed with intestinal ileus in the emergency department was aimed. Methods: Our study was carried out as a prospective cohort between 23.11.2021 and 07.04.2022. Patients aged 18 years and older who applied to the emergency department and were diagnosed with intestinal ileus after clinical, laboratory and radiological evaluation were included in the study. Demographic characteristics, comorbidities, treatments, laboratory tests and IG, IG/TG results of the patients were recorded. The patients were divided into two groups as those who underwent surgical treatment and those who did not, and comparisons were made. p value &amp;lt;0.05 was considered statistically significant. Results: A total of 78 patients were included in the study. 46.2% (n=36) of the patients were female and the median age was 65 years. While surgery was performed in 41% (n=32) of the patients, 59% (n=46) were followed up with medical treatment. IG number and IG/TG ratio were found to be higher in patients who underwent surgical intervention than in those who underwent medical treatment, and these differences were statistically significant (p&amp;lt;0.05). In receiver-operating characteristic (ROC) analysis AUC: 0.658 was found for IG number. With the best cut-off value of 0.03, the sensitivity was found to be 56.3% specificity: 71.7%; and the AUC value for IG/TG: 0.627 (95% CI; 0.500-0.753), and when the best cut-off value was taken as 0.2, the sensitivity for this value was 59.4%, and the specificity was 63%. Conclusion: In this study, in which we examined the IG numbers and IG/TG ratios in patients with intestinal ileus, although we showed that these parameters were higher in patients who needed surgical treatment, upon the analysis done, we believe that it is not a clinically significant marker.

OUR EXPERIENCE IN THE USE OF BONE-CARTILAGE AUTOPLASTY IN THE TREATMENT OF PATIENTS WITH OSTEOCHONDRAL PATELLAR DEFECTS

Objective: to evaluate the effectiveness of bone-cartilage autoplasty in the treatment of patients with osteochondral patellar defects. Materials and methods. The study analyzed the results of surgical treatment of 7 patients for the period from 2012 to 2023 inclusive. All patients underwent inpatient treatment at the Department of Traumatology and Orthopedics No. 2 Clinics of Samara State Medical University (SamSMU). All patients had a defect of patellar cartilage on the background of osteoarthritis of the knee joint with a predominant lesion of the patellofemoral joint (patellofemoral arthrosis). Bone-cartilaginous autoplasty of the articular surface of the patella was used as an operation. Clinical evaluation of treatment results was carried out on the basis of the methods recommended by OARSI (Osteoarthritis Research Society International) before surgery and at 3, 6 and 12 months after surgery: VAS (Visual Analog Scale), WOMAC Index (Western Ontario and McMaster University Osteoarthritis Index) and M. Lequesne algofunctional index were determined. The condition of bone-cartilage tissue in the defect area before surgery and after bone-cartilage autoplasty was assessed using radiography and magnetic resonance imaging. Results and discussion. We noted that according to the studied indices and scales, the greatest positive dynamics was observed in the early postoperative period (3 months), the peak reached by 6 months, and full functional recovery occurred by 12 months (return to sports, high-intensity work). The most complete restructuring as a result of the examination of 7 patients according to radiography and MRI, we noted at the time of 6 months, when we see a complete restructuring of the patellar cartilage tissue, as well as the greatest signs of autograft integration in the subchondral zone. Conclusions. The use of bone-cartilage autoplasty as a method of surgical treatment in patients with osteochondral injuries of the patella in clinical practice is effective, expedient and its use in clinical practice is recommended from the standpoint of restoring the function of the knee joint, which leads to an improvement in the quality of life of patients. Nevertheless, its application requires taking into account all anatomical and functional features of the patellofemoral articulation.

309. SURGICAL TREATMENT FOR THE RECURRENT SITE OF ESOPHAGEAL CANCER AFTER ESOPHAGECTOMY

Abstract Background Although the outcome of patients with recurrent esophageal cancer following radical esophagectomy is extremely poor, long-term survival can be achieved with multimodal therapy, including surgical resection of the recurrent lesion. Developing a treatment strategy is a critical issue; therefore, we examined the indications and optimal timing for surgical treatment in patients with recurrence. Methods A total of 184 patients with recurrent esophageal cancer after radical esophagectomy were studied between 2001 and 2015, with a focus on surgical resection. Results The first recurrence site was the lymph nodes (124 cases; 67%) [neck (35; 19%), mediastinum (82; 45%), abdomen (35; 19%)], lung (36; 20%), liver (32; 17%), pleura (18; 10%), bone (13; 7%), etc. Second-line treatment following recurrence was surgery (8 cases), chemoradiotherapy (89 cases), chemotherapy (64 cases), and best supportive care (23 cases). Patients with single organ or solitary recurrence and recurrence more than 8 months after surgery had better prognoses. All the surgical cases had single-site recurrence (lung-3, cervical lymph nodes-3, colon-1, and brain-1). Good prognosis was expected for the patients with lung or cervical lymph node recurrence. Conclusion Surgical treatment for recurrent esophageal cancer following radical esophagectomy was considered beneficial for the recurrence of cervical lymph node or lung metastasis of solitary lesions at least 8 months after esophagectomy. Immune checkpoint inhibitors have recently been indicated for esophageal cancer and expected for improving prognosis, and the role of surgery in multidisciplinary treatment for metastatic recurrence needs repeated investigation.

Perioperative management, operative techniques, and pitfalls in the surgical treatment of patients with diffuse idiopathic skeletal hyperostosis: a narrative review

Diffuse idiopathic skeletal hyperostosis (DISH) can lead to dysphagia, airway obstruction, and unstable vertebral fractures. Surgery can be performed to relieve cervical compression or stabilize fractures of the spinal column, with or without decompression of spinal cord injuries. In this review, the peri-operative surgical techniques in cases with DISH are discussed, as well as the pre-operative and post-operative pearls and pitfalls. It is essential for spine surgeons, including orthopedic surgeons and neurosurgeons, to be aware of the considerations, anticipations, and approaches for the management of dysphagia, airway obstruction, and fractures in DISH patients in order to improve patient outcomes for this specific at-risk patient population.

The role of concomitant vitamin D3 and K2 treatment after laminectomy in spinal stenosis surgery of patients with osteoporosis

Background: Readmission because of ongoing pain and complaints who undergone spinal surgery with osteoporosis is increasing. This study investigated the efficacy of concomitant vitamin D3 and K2 usage in the surgical treatment of patients with lumbar spinal stenosis who have osteoporosis. The aim of the study was to treatment strategy is to reduce the patient’s low back pain and decrease readmission rates due to ongoing pain. Methods: A total of 22 patients with osteoporosis included in the study who had lumbar decompression via laminectomy surgery with posterior instrumentation for spinal stenosis. Patients were divided into groups according to use additional supplement of vitamin D3+K2. Group 1 was control group who received only vitamin D3 and group 2 was patients who received vitamin D3+K2 treatment. Patients were called to their sixth month check-up and their pre-and post-treatment VAS scores and Roland-Morris scores were filled in and readmission rates due to ongoing pain were compared. Results: 9 male and 13 female participants with a mean age of 64.4 were in the study. The mean T-score in bone mineral density (BMD) was -2.7 in group 1 and -2.6 in group 2. A significant difference was found when the pre-operative and post-operative VAS and RM scores of all patients were compared (p&lt;0.05). The mean readmission rates due to ongoing pain is 4 in group 1 and 7 in group 2. A significant difference was found when readmission rates due to ongoing pain were compared (p&lt;0.05). Conclusions: Concomitant vitamin D3 and K2 usage in the surgical treatment of patients with lumbar spinal stenosis who have osteoporosis is a valuable treatment option to reduce the rate of admission to the hospital because of ongoing pain.

Outcome of Superomedial Pedicle Flap for Lower Outer Quadrant Breast Cancer

Abstract Background Breast cancer is the most common cancer among women and is the second leading cause of cancer deaths. The surgical treatment of patients with breast cancer involves either breast conserving surgery or mastectomy, both of which can result in considerable asymmetry of the breasts. Breast reconstruction offers restoration of breast symmetry to such women. The patient needs to be aware that the reconstructed breasts will neither feel nor function like a normal breast but may help in restoring body image and self-confidence. Objective To evaluate the intraoperative and postoperative outcomes and showing advantages and disadvantages of Superiomedial pedicle flap for lower outer quadrant breast cancer in cup ≥ c. Patients and Methods It was a prospective study that included 10 patients aiming to assess outcome of the superomedial pedicle flap oncoplastic technique for lower outer quadrant breast cancer in oversized breast. This study was conducted at Ain Shams University Hospitals. Approval of the ethics committee and written informed consent from all participants were obtained. Results In our study, all of the patients had free safty magins as confirmed by the pathologist in our MDT proving that we had performed a superior medial technique safely from the oncological point of view. We were able to conduct an excellent cosmetic outcome for relatively large tumor excisions which fall in good and fair score groups as those two patients noticed asymmetry of the two breasts. None of our cases have had a poor or an ugly score. Overall, the satisfaction rate with this technique was high, with very few and easily manageable complications. There were no cases of NAC loss. Conclusion Superomedial pedicle can be safely utilized in large size breast reduction without increase of NAC necrosis. The technique is an efficient method to achieve minimal to moderate breast reduction with minimal NAC transposition. The primary surgical goals are attained by appropriate resection of the breast parenchyma. Moreover, a youthful and aesthetically appealing breast is achieved by maintaining superior and medial fullness and reshaping the breast using the parenchyma and skin envelope for support. Superomedial pedicle flap technique offers breastconserving surgery with wider margins offering safer oncologic control with more satisfactory cosmetic outcome.

Same-gender differences in perioperative complications and transfusion management for lower limb arthroplasty

IntroductionTotal hip (THA) and knee arthroplasty (TKA) are surgical interventions for patients with primary and posttraumatic osteoarthritis. The present clinical investigation compared gender differences in THA and TKA.MethodsData from 419 patients following primary THA and TKA were collected. The occurrence of systemic and surgery-related complications, the units of blood transfused, and the change in Hb were investigated. Hb was collected preoperatively and at 1, 2, 4 and 7 days postoperatively. Statistical analysis was performed using the software IBM SPSS 28.ResultsThere was no significant difference in surgery-related and general complications in men between THA and TKA. A significant difference between THA and TKA in systemic complications in women was observed. No significant difference between THA and TKA in related to surgery-related complications was evidenced. In men, no difference in Hb progression was observed. In women, a significant Hb drop was evidenced (p = 0.03). The rate of blood transfusion units in women was significantly greater in TKA than in THA (p = 0.001). No statistically significant difference was observed in men in the rate of transfusion between THA and TKA.ConclusionPerioperative care should be organized differently for women and men. Furthermore, a differentiation between the procedures for each sex could prevent the occurrence of perioperative complicated courses.