Traditional Surgical Treatment Research Articles

Nonselective lumbosacral ventral-dorsal rhizotomy for the management of lower-limb hypertonia in nonambulatory children with cerebral palsy.

Children with cerebral palsy (CP) often experience medically refractory hypertonia, for which there are surgical therapies including neuromodulation and rhizotomy. Traditional surgical treatment for medically refractory mixed hypertonia or dystonia includes intrathecal baclofen pumps and selective dorsal rhizotomy. A nonselective lumbosacral ventral-dorsal rhizotomy (VDR; ventral and dorsal roots lesioned by 80%-90%) has the potential to address the limitations of traditional surgical options. The authors highlighted the institutional safety and efficacy of nonselective lumbosacral VDR for palliative tone management in nonambulatory patients with more severe CP. The authors performed a retrospective analysis of patients who had undergone lumbosacral VDR between 2022 and 2023. Demographic factors, clinical variables, and operative characteristics were collected. The primary outcomes of interest included tone control and quality of life improvement. Secondary outcome measures included, as a measure of safety, perioperative events such as paresthesias. Postoperative complications were also noted. Fourteen patients (7 female) were included in the study. All patients had undergone a T12-L2 osteoplastic laminoplasty and bilateral L1-S1 VDR. Nine patients had quadriplegic mixed hypertonia, 4 had quadriplegic spasticity, and 1 had generalized secondary dystonia. Following VDR, there was a significant decrease in both lower-extremity modified Ashworth Scale (mAS) scores (mean difference [MD] -2.77 ± 1.0, p < 0.001) and upper-extremity mAS scores (MD -0.71 ± 0.76, p = 0.02), with an average follow-up of 3 months. In the patient with generalized dystonia, the lower-extremity Barry-Albright Dystonia Scale score decreased from 8 to 0, and the overall score decreased from 32 to 13. All parents noted increased ease in caregiving, particularly in terms of positioning, transfers, and changing. The mean daily enteral baclofen dose decreased from 47 mg preoperatively to 24.5 mg postoperatively (p < 0.001). Three patients developed wound dehiscence, 2 of whom had concurrent infections. Lumbosacral VDR is safe, is effective for tone control, and can provide quality of life improvements in patients with medically refractory lower-limb mixed hypertonia. Lumbosacral VDR can be considered for palliative tone control in nonambulatory patients with more severe CP. Larger studies with longer follow-ups are necessary to further determine safety and long-term benefits in these patients.

Improving surgical treatment of patients with patellar instability

BACKGROUND: The high frequency and recurrence of chronic patellar instability and the lack of unified treatment techniques indicate the need for a comprehensive individualized approach in the diagnosis and surgical treatment of patellar instability.&#x0D; AIM: To develop an algorithm and compare the anatomical and functional results of its use with those of traditional surgical treatment of patients with patellar instability.&#x0D; MATERIALS AND METHODS: The functional results of the treatment of 194 patients with patellar instability were compared. Two groups of patients were formed. The surgical treatment techniques of the main group (n = 93) were based on the results of the preoperative examination, considering risk factors of instability development, established as a result of retrospective analysis of the control group (n = 101). The effectiveness of the algorithm was compared with the techniques of patellar stabilization used from 2010 to 2015. The Kujala, IKDC 2000, and Lysholm scales were used to assess the functional results of treatment.&#x0D; RESULTS: Surgical treatment of instability aims to eliminate risk factors such as anomalies of the extensor apparatus of the knee joint and to repair or reconstruct damaged structures. Plasty of the medial patellofemoral ligament is the method of choice for patellar stabilization. In the case of dysplastic changes in the patellofemoral joint, combinations of proximal and distal knee joint surgeries were performed. Rotational lower-limb deformities were treated by corrective derotational osteotomy of the femur. Trochleoplasty was performed in cases of type B or D femoral block dysplasia. Patients with stiff lateral patellar retention underwent lateral release or extension tenotomy. In both groups, the functional status of the patients significantly (p 0.05) improved 12 months postoperatively. The mean values of the functional scales increased because of the increased number of patients with excellent and good scores in the group. Higher values were recorded in the main group (Kujala, p = 0.038; IKDC 2000, p = 0.021; Lysholm, p = 0.032). Patellar dislocation recurred in 2 (1.9%) patients in the control group (p = 0.172).&#x0D; CONCLUSIONS: The proposed algorithm helped verify the degree, type, and etiology of patellar instability and helped obtain better anatomofunctional treatment results in patients.

Surgical Treatment of a Large Isolated Aneurysm of the Right Primary Iliac Artery: About A Case

Isolated iliac artery aneurysms are extremely rare, accounting for less than 2% of all aneurysmal diseases. These aneurysms are usually seen in older men. Very mildly symptomatic but carries a significant risk of rupture when the aneurysms have reached a large size. Their operative mortality is significantly higher when undertaken as an urgent or elective procedure, highlighting the importance of early diagnosis and appropriate management. The development of radiological exploration methods has facilitated the discovery and diagnosis of these aneurysms. The emergence of endovascular techniques constitutes an alternative to traditional surgical treatment. We report our surgical management of an aneurysm of the primary iliac artery isolated in a 71-year-old man, who benefited in our department from a resection of the aneurysm with restoration of continuity by a prosthetic bypass. The objective of this article is to present and describe the diagnostic assessment; imaging data, treatment methods as well as a review of the literature concerning the history of iliac artery aneurysms.

Outcomes of Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy with Two-Year Minimum Follow-Up: A Retrospective Study

Introduction/Purpose: Insertional Achilles tendinopathy (IAT) is a common source of posterior heel pain treated by orthopaedic foot and ankle surgeons. Traditional surgical treatment consists of an open Achilles tendon debridement with re-attachment as well as excision of the posterosuperior calcaneal prominence with or without a gastrocnemius recession. However, frequent complications include wound healing issue, scar pain, weakness and sural nerve injury. Accordingly, the percutaneous ZO is gaining popularity in the field as an alternative to an open midline splitting approach. Limited literature exists describing outcomes of the percutaneous ZO using a larger sample size. The purpose of this study was to analyze patient reported outcomes and complications after percutaneous ZO with a minimum two-year follow-up period. Methods: One hundred and eight cases treated with percutaneous ZO were retrospectively reviewed across October 2017-July 2021 and outcomes data was available for 104 cases with a minimum two-year follow-up. Patient sex, age, and pertinent comorbidities were recorded. Postoperative complications and patient satisfaction following intervention were evaluated. Foot Function Index score (FFI) was utilized to measure patients’ pain and functional outcomes. Visual Analyzing Scale score (VAS) was also utilized to evaluate pain. These measurements were taken at preoperative and final follow-up. Statistical comparisons were performed using two-tailed, paired t-test with p&lt; 0.05. Results: Mean follow-up time was 41.2±13.1 months (range 24-65 months). The mean FFI score improved from 56.1±5.9 (range 47-88) preoperatively to 11.0±5.1 (range 7-59) postoperatively (p &lt; 0.001). Average VAS score improved in patients receiving percutaneous ZO from 7.6±1.3 (range 5-10) to 0.4±0.9 (range 0-7) postoperatively (p &lt; 0.001). The overall complication rate was 3.8% (N =4). Of 104 cases, 98.1% of patients were satisfied with their procedure (102/104). Conclusion: The percutaneous ZO is a safe and highly effective intervention for treatment of IAT. At a minimum of two-years follow-up, this intervention is associated with minimal complications, improved functional outcomes, reduced pain, and high patient satisfaction. Table 1 Functional and subjective pain preoperative and postoperative scores as evaluated by functional foot index (FFI) and visual analogue scale (VAS), respectively

Trends in research related to fetal therapy from 2012 to 2022: a bibliometric analysis.

The development of prenatal diagnosis technology allows prompt detection of severe fetal diseases. To address adverse factors that threaten fetal survival, fetal therapy came into existence, which aims to preserve the function after birth to a higher degree and improve the quality of life. To conduct a comprehensive bibliometric analysis of studies on fetal therapy in the past decade and explore the research trends and hotspots in this field. We conducted a systematic search on the Web of Science Core Collection to retrieve studies related to fetal therapy published from 2012 to 2022. VOSviewer and CiteSpace were used to analyze the key features of studies, including annual output, countries/regions, institutions, authors, references, research hotspots, and frontiers. A total of 9,715 articles were included after eliminating duplicates. The annual distribution of the number of articles showed that the number of articles published in fetal therapy had increased in the past decade. Countries and institutions showed that fetal therapy is more mature in the United States. Author analysis showed the core investigators in the field. Keyword analysis showed the clustering and emergence frequency, which helped summarize the research results and frontier hotspots in this field. The cocited references were sorted out to determine the literature with a high ranking of fetal therapy in recent years, and the research trend in recent years was analyzed. This study reveals that countries, institutions, and researchers should promote wider cooperation and establish multicenter research cooperation in fetal therapy research. Moreover, fetal therapy has been gradually explored from traditional surgical treatment to gene therapy and stem cell therapy. In recent years, fetoscopic laser surgery, guideline, and magnetic resonance imaging have become the research hotspots in the field.

Successful treatment of severe purulent peritonitis against the background of intraperitoneal hypertension syndrome (clinical case)

Traditional surgical treatment of widespread purulent peritonitis has some disadvantages that emphasizes the need for new approaches to postoperative care. The authors present successful treatment of diffuse purulent peritonitis using a combination of 'open abdomen' technology and VAC therapy. This approach reduces abdominal inflammation and intra-abdominal pressure. Combination of 'open abdomen' technology and VAC therapy provides effective control of inflammation and stabilization of patients with purulent peritonitis.

Effect of navigation endoscopy combined with three-dimensional printing technology in the treatment of orbital blowout fractures.

To explore the combined application of surgical navigation nasal endoscopy (NNE) and three-dimensional printing technology (3DPT) for the adjunctive treatment of orbital blowout fractures (OBF). Retrospective analysis was conducted on the data of patients with OBF who underwent surgical treatment at the Affiliated Eye Hospital of Nanchang University between July 2012 and November 2022. The control group consisted of patients who received traditional surgical treatment (n=43), while the new surgical group (n=52) consisted of patients who received NNE with 3DPT. The difference in therapeutic effects between the two groups was evaluated by comparing the duration of the operation, best corrected visual acuity (BCVA), enophthalmos difference, recovery rate of eye movement disorder, recovery rate of diplopia, and incidence of postoperative complications. The study included 95 cases (95 eyes), with 63 men and 32 women. The patients' age ranged from 5 to 67y (35.21±15.75y). The new surgical group and the control group exhibited no statistically significant differences in the duration of the operation, BCVA and enophthalmos difference. The recovery rates of diplopia in the new surgical group were significantly higher than those in the control group at 1mo [OR=0.03, 95%CI (0.01-0.15), P<0.0000] and 3mo [OR=0.11, 95%CI (0.03-0.36), P<0.0000] post-operation. Additionally, the recovery rates of eye movement disorders at 1 and 3mo after surgery were OR=0.08, 95%CI (0.03-0.24), P<0.0000; and OR=0.01, 95%CI (0.00-0.18), P<0.0000. The incidence of postoperative complications was lower in the new surgical group compared to the control group [OR=4.86, 95%CI (0.95-24.78), P<0.05]. The combination of NNE and 3DPT can shorten the recovery time of diplopia and eye movement disorder in patients with OBF.

Functional results of surgical treatment of macular holes fully preserving the internal limiting membrane as compared with the traditional method

Purpose: to assess the functional results of surgical treatment of macular holes (MH) using the authors’ developed technology preserving the internal limiting membrane (ILM) and compare them with the results of traditional surgery technology involving ILM peeling.Material and methods: 150 MH patients aged 50 to 82 were divided into 2 groups: the main group who underwent surgical MH treatment with ILM preservation and the control group, whose traditional surgical treatment involved ILM peeling. After vitrectomy, the main group patients’ macular areas were treated with a bacterial collagenase solution (1 kU) for three minutes, whereupon it was washed out, the vitreal cavity was dried and treated with platelet-rich plasma. In the control group, ILM was stained and removed, whereupon platelet-rich plasma was applied in the air medium. The anatomical result was assessed by optical coherence tomography data. To assess the functional results, the patients were tested for the best corrected visual acuity (BCVA) and subjected to microperimetry. The observation period was 24 months.Results: in all cases, a significant increase in BCVA was achieved after surgical treatment. After 6 months, the control group showed a tendency to a BCVA decrease, while in the main group BCVA remained stable. In the main group, not a single case showed a decrease in the total retinal photosensitivity below the threshold level of the norm of 24 dB, whilst in the control group, 35 cases (47 %) revealed a retinal sensitivity decrease below 24 dB. The total retinal sensitivity turned out to be significantly lower in the control group as compared to the main group over the entire observation period (p &lt; 0.05). Postoperative scotomas were significantly more frequent after ILM peeling. Absolute scotomas were detected in 7 control group cases, whilst in the main group they were not noted in any case.Conclusion. The developed technology makes it possible to practically eliminate the formation of absolute scotomas and to significantly reduce the formation of relative scotomas in the postoperative period, as well as improve functional results against the traditional method of surgical treatment of MH with ILM peeling.

Prostatectomy postoperative urinary incontinence: From origin to treatment

AbstractProstate cancer is a common malignant tumor at present, and there are still adverse reactions after radical prostatectomy. As many as 30% of patients complain of urinary incontinence (UI). This review begins with the pathophysiological basis of post‐prostatectomy urinary incontinence (PPUI) and describes the maintenance of normal urine control function, anatomical changes, and urodynamic maintenance of PPUI. Then, we talk about the various influencing factors of UI, for example, the differences caused by the basic condition of the patient, the length of the membranous urinary tract, the level of prostate‐specific antigen before operation, the method and technique of operation, and so on. Last, we introduce all kinds of treatments of PPUI in detail. It includes noninvasive conservative treatment, traditional surgical treatment, emerging stem cell therapy treatment, and postoperative psychotherapy of PPUI. The present situation of the treatment of UI after prostatectomy is summarized, and the prospect of the technology is put forward.

Application of Foley balloon catheter in palliative surgery for pulmonary atresia with an intact ventricular septem, with additional cases of pulmonary atresia with ventricular septal defect and tetralogy of Fallot

BackgroundPulmonary atresia and tetralogy of Fallot can require palliative surgery in the neonatal period due to severe hypoxia; however, limitations of established techniques include high failure rate and need for cardiopulmonary bypass. Herein, right ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter is described.MethodsA retrospective review of patients who underwent right ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter at our institution between September 2018 and March 2022 was completed. During the procedure, a Foley balloon catheter was used to occlude the blood from the right ventricular inflow tract.ResultsEight patients with pulmonary atresia and intact ventricular septum underwent an off-pump right ventricular outflow tract reconstruction. One patient with pulmonary atresia and ventricular septal defect, and two patients with tetralogy of Fallot underwent an on-pump right ventricular outflow tract reconstruction on a beating heart. The procedures were successful in all patients. Patent ductus arteriosus ligation without modified Blalock-Taussig shunt placement was performed in three patients with pulmonary atresia with intact ventricular septum and two patients with tetralogy of Fallot, ductus arteriosus was left open in four patients with pulmonary atresia with intact ventricular septum. All patients remained clinically well without serious complications.ConclusionsRight ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter for pulmonary atresia and tetralogy of Fallot is a feasible alternative to catheter-based interventions or traditional surgical treatment, especially in patients with muscular infundibular stenosis or hypoplastic pulmonary annulus. Further studies with more cases are needed to verify feasibility and superiority of this approach.

Direct cost variance analysis of peroral endoscopic myotomy vs heller myotomy for management of achalasia: A tertiary referral center experience.

Laparoscopic Heller myotomy (LHM) has been the traditional surgical treatment for achalasia. Recently, peroral endoscopic myotomy (POEM) has demonstrated similar clinical outcomes with shorter procedure times. Studies comparing the direct cost-effectiveness of POEM vs LHM are limited. To compare costs of POEM vs LHM. This retrospective chart review aimed to compare the outcomes and cost of clinical care between patients who underwent POEM and LHM procedures for achalasia. The study was conducted at a tertiary academic center from January 2019 to December 2020. Clinical outcomes, including post-operative Eckardt scores and adverse events, were assessed and compared between the two groups. Direct cost variance analysis was utilized to evaluate the cost of clinical care incurred by patients undergoing POEM in the year preceding the procedure, during the index admission, and one year post-procedure, in comparison to patients undergoing LHM. Of 30 patients were included (15 POEM and 15 LHM) in the study. Patients in the POEM group had a mean Eckardt score of 0.5 ± 0.5 post-procedure, which was no different from patients in the LHM group (0.7 ± 0.6, P = 0.17) indicating comparative efficacy. However, the total costs of the admission for the procedure in the LHM group were on average $1827 more expensive than in the POEM group (P < 0.01). Total healthcare costs one year prior to index procedure were $7777 higher in the LHM group, but not statistically different (P = 0.34). The patients in the LHM group one year after the index procedure had accrued $19730.24 larger total cost, although this was not statistically different from POEM group (P = 0.68). Despite similar clinical outcomes, the cost of the index procedure admission for POEM was significantly lower than for LHM. The difference was primarily related to shorter time increments utilized in the operating room during the index procedure, and shorter length of hospital stay following POEM.

Effectiveness of Surgical Treatment Acute Hematogenic Osteomyelitis Children in the Complex With Ozone Therapy and Lymphogenic Technology

The results of operative treatment of acute hematogenous osteomyelitis in 96 children aged from 3 to 12 years are presented. The control group consisted of 52 patients who had traditional surgical treatment and 44 children who were operated according to the developed method in combination with ozone therapy and the use of lymphogenous technology. Transition to the chronic form in the control group was 13.4%, and in the primary group 6.8%.

The therapeutic effect of chlorpropamide combined with surgery on neurogenic anorexia in glaucoma patients

BackgroundGlaucomatous patients with anorexia nervosa may face conditions such as poor physical fitness during their daily lives, such as absorption and digestive disorders in the digestive system, and susceptibility to circulatory diseases. Traditional surgical treatment may not achieve ideal results for the needs of such patients. In view of this, the study aims to explore whether the combination of chlorpromazine and surgical treatment can bring better treatment methods and effects to patients with anorexia nervosa in glaucoma. Through in-depth analysis of the characteristics of chlorpromazine and the etiology of neuroanorexia in glaucoma patients, the study provided a new treatment method for such patients.Subjects and MethodsThe study selected 60 glaucoma patients with anorexia nervosa as the research subjects and randomly divided them into an experimental group and a control group. The experimental group patients were treated with chlorpromazine combined with surgery, while the control group patients were treated with surgery only. The study used the Minnesota Multi-personality Inventory (MMPI) to evaluate the intervention of anorexia nervosa in glaucoma patients.ResultsBefore the experiment, there was no significant difference in the scores of anorexia nervosa between the two groups of patients (MMPI&gt;60). After the experiment, patients in the experimental group showed significant improvement in anorexia nervosa, which was significantly lower than those in the control group (MMPI&lt;40).ConclusionsThe combination of chlorpromazine and surgical treatment can significantly alleviate the neurological anorexia of glaucoma patients, which has a positive effect on their physical health.

Intramedullary vs Plate Fixation of Distal Fibular Fractures: Use Rates, Fracture Patterns, Patient Characteristics, and Complication Rates

Category: Trauma; Ankle Introduction/Purpose: The traditional surgical treatment for distal fibula fractures is open reduction and plate fixation (PF). However, intramedullary fixation (IMF) has been shown to provide advantages over plate fixation, particularly in patients and injuries with higher risks of soft tissue complications. Current evidence comparing the two fixation types remains scarce and is limited by modest sample sizes. Using a large national database, this retrospective cohort study aims to examine differences in use rates, associated fracture patterns, patient characteristics (e.g. age, gender, comorbidities, Elixhauser Comorbidity Index (ECI)), and complication rates between fibular IMF and PF within the United States. Methods: Patients (age≥18) with lower leg or ankle fractures treated with fibular IMF or PF between October 2015 and October 2021 were identified using a United States insurance claims database. The monthly ratio of IMF-treated patients to PF-treated patients was tracked over time to compare use rates. Fracture patterns were determined using fracture diagnoses within one month preceding surgery. Further analyses of patient characteristics and complication rates only included fibula fracture patients with 12 months of post-operative follow-up, and patients with concomitant upper tibia or tibia shaft fractures were excluded. To compare complication rates, a 1:4 (IMF:PF) matched comparison was performed, controlling for age, gender, high-energy (i.e. pilon, lower tibia, and trimalleolar) fractures, diabetes, tobacco use, obesity, and chronic kidney disease (CKD). Comparisons were conducted using chi-squared tests for categorical variables and t-tests for means. Ordinary least squares regression was used to visualize the trend in monthly relative use rates. Results: In total, 39329 patients (2294 IMF, 37035 PF) were identified. IMF use trended upwards relative to PF use over time (Figure 1). Tibia and fibula shaft fractures were the most common fractures in IMF patients versus trimalleolar and bimalleolar fractures in PF patients. A higher proportion of IMF patients had open fractures (p &lt; 0.01). 627 IMF and 29703 PF patients were included for further analysis of patient characteristics and complications. The IMF cohort was younger, with higher mean ECI, fewer females, and higher rates of CKD (ps &lt; 0.01). No significant differences in diabetes, tobacco use, or obesity rates were identified. Among 316 IMF and 1254 PF matched patients, no significant differences in infection, nonunion, malunion, revision, hardware removal, pulmonary embolism, and deep vein thrombosis rates were found. Conclusion: The upward trend in the ratio of IMF-treated to PF-treated patients suggests that the popularity of IMF is steadily rising. The higher rate of concomitant tibia shaft fractures and open fractures seen among IMF-treated patients in this study is consistent with the use of fibular IMF in cases involving higher-energy trauma and soft-tissue disruption. Higher ECI scores and rates of CKD in IMF patients also suggest that IMF is used more frequently in medically complex patients with impaired wound healing. Lastly, fibular IMF appears to be a viable alternative to PF when used in similar populations.

The clinical value of radical resection of retroperitoneal lipo-lymphatic layer for pancreatic head cancer

Objective: To investigate the clinical value of the novel approach,radical resection of the retroperitoneal lipo-lymphatic layer (RRRLLL),in the surgical treatment of resectable pancreatic head cancer. Methods: Between June 2020 and June 2022,a total of 221 patients with pancreatic head cancer underwent surgical treatment using the RRRLLL approach(RRRLLL group),while 107 patients received traditional surgical treatment(traditional group) in five high-volume pancreatic centers in China. Data from surgical technique and clinical perioperative outcomes,including lymph node harvested,surgical time,and complications,were analyzed. The RRRLLL group consisted of 144 males and 77 females with an age of (67.5±9.0) years(range:41.3 to 81.1 years). The traditional group included 71 males and 36 females,with an age of (66.3±8.1) years(range:45.1 to 79.2 years). Statistical analysis was performed using the K-S test,Z test,or χ2 test. Results: Pancreaticoduodenectomy was performed successfully in all patients,achieving R0 resection. RRRLLL group surgery required mobilization of retroperitoneal adipose and lymphatic tissues starting from the right edge of the inferior vena cava and extending to the left side,up to the superior mesenteric artery,down to the inferior mesenteric artery,and left to the left side of the aorta,including the perineural and lymphatic tissues around the superior mesenteric artery and the sheath of the mesenteric artery. However,the traditional group did not include the areas mentioned above in the scope of clearance. There were no statistically significant differences between the RRRLLL group and the traditional group in terms of age,sex,tumor size,T stage,and vascular invasion (all P>0.05). However,the number of lymph nodes harvested in the RRRLLL group was significantly higher at 28.7±9.0 (range: 18 to 39) compared to 18.2±8.0 (range: 12 to 21) in the traditional group (Z=-10.691,P<0.05). There were no statistically significant differences in the number of positive lymph nodes,N staging,and postoperative complications between the two groups. Conclusion: The RRRLLL approach improved lymph node dissection compared to the traditional approach,potentially leading to reduced recurrence rates.

Long-term outcomes and complications of isolated anterior thoracolumbar fusion for neuromuscular scoliosis associated with myelomeningocele.

Neuromuscular scoliosis associated with myelomeningocele is a difficult clinical dilemma for the treating surgeon. The traditional surgical treatment consists of a posterior spinal instrumented fusion with or without a combined anterior procedure, but this has been associated with high complication rates, mostly related to deep infection. An anterior thoracolumbar fusion is not able to address the entirety of the deformity in many cases but could potentially avoid the devastating infection risks from the posterior approach by avoiding compromised skin. This study aims to evaluate the long-term outcomes and complications associated with isolated anterior thoracolumbar fusion in this high-risk group. This study is a retrospective analysis of patients with myelomeningocele-associated scoliosis treated with an isolated anterior spinal fusion over a 20-year time period at a single center. Surgical details, demographics, curve characteristics and complications were recorded. Comparisons were made between patients who required revision surgery and those who did not. Sixteen patients were enrolled with an average age of 12.7years at the time of surgery and average follow-up of 5.5years. Patients had on average 7.4 levels fused anteriorly with the most common levels being T10-L4. There were no deep wound infections associated with the anterior surgery. Overall, nine patients (56%) had to be revised posteriorly due to adding-on or junctional deformity at an average of 3.7years after index procedure. Four patients were revised due to proximal adding-on, while 1 was extended distally. Four additional patients were extended both proximally and distally. Of the posterior revisions, 2 patients developed deep wound infections, and both of these were in patients extended distally. Preoperative lumbar lordosis was higher in patients who required distal extension (100 vs. 69 degrees; p = 0.035). Patients undergoing isolated anterior fusion for scoliosis associated with myelomeningocele have low infection rates but often require posterior revision. The majority of patients can avoid the deep infection risk associated with distal posterior surgery at long-term follow-up. IV.

Endoscopic treatment of lumbar ligamentum flavum cyst by interlaminar approach: a minimally invasive and effective alternative to open surgery

Background and objectivesLumbar ligamentum flavum cyst is a rare spinal condition that can cause significant morbidity and neurological deficits. Traditional surgical treatment involves open surgery, which can be associated with prolonged recovery time and significant morbidity. In recent years, endoscopic treatment of lumbar ligamentum flavum cyst has emerged as a minimally invasive and effective alternative to open surgery, but only a few cases have been reported in the literature. This paper describes our experience with endoscopic resection of an L4/5 ligamentum flavum cyst through an interlaminar approach and reviews the literature on the treatment of lumbar ligamentum flavum cyst.MethodsAn 87-year-old man presented with lameness in the left leg, and magnetic resonance imaging (MRI) showed nerve compression by a ligamentum flavum cyst at the L4/5 intervertebral plane. The patient underwent endoscopic resection of the ligamentum flavum cyst through a left interlaminar approach with the facet joint preserved. The present study was approved by the Ethics Committee of our hospital. The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Text regarding patient consent is not applicable for this case.ResultsPostoperative clinical results improved significantly, and postoperative MRI showed complete cyst resection.ConclusionTotal endoscopic resection via an interlaminar approach provides a new minimally invasive approach for the surgical treatment of lumbar ligamentum flavum cyst, which can be used as a reference by clinicians.

Staged Repair of Primary Aortoesophageal Fistula.

Primary aortoenteric fistulas are rare with an incidence reported up to .07% at autopsy. Literature review yields few reported cases, and rarer still is a fistula between a normal thoracic aorta and the esophagus. Rather, 83% of cases are associated with an aneurysmal aorta and 54% involve the duodenum. Patients with aortoesophageal fistula (AEF) usually present with a triad of chest pain, dysphasia, and a herald bleed. Without treatment, AEFs will result in exsanguination and are universally fatal; even with traditional open surgical treatment, mortality is reported over 55%. The complex pathology of AEFs makes repair more challenging, given an infected field, friable tissue, and patients who are often hemodynamically unstable. Staged repair using endografts as initial treatment with the primary goal of controlling bleeding and preventing fatal exsanguination has been reported. We present a case where a descending thoracic aorta to esophageal fistula was repaired, and this strategy was utilized.

The Application of CAR-T Cell Therapy

Cancer is undoubtedly the number one killer in today's society. Traditional surgical treatment methods have their own limitations, especially in the treatment of end-stage or hematological tumors. Emerging immunotherapy is an unprecedented breakthrough technology in cancer treatment. For example, PD-1/PD-L1 and CAR-T immunotherapy. CAR-T has been proposed for many years, it is only in the last few years that it has been improved and applied in the clinic. Its effectiveness in the treatment of cancer in hematology is encouraging. For example, it has a great curative impact in the acute leukemia, in the field of non-Hodgkin lymphoma ,it is also recognized as one of the most prospective and developed tumor treatments. Clinical application of CAR-T has attracted extensive attention. This therapy is characterized by the ability to detect tumor-associated antigens preferentially detected by T cells, which has a significant anti-tumor effect. This article will focus on HCC, list the existing HCC CAR-T treatment targets and briefly describe associated clinical research.

Distal Ulna Fracture Fixation with the Specialized Threaded Pin

Distal ulna fractures can often be treated nonsurgically; however, many surgeons consider significant displacement or instability, especially following fixation of an associated distal radius fracture, an indication for surgical fixation because of potential problems associated with malunion of these fractures. Traditionally, these fractures have been addressed with plate fixation but hardware in this location is often prominent and associated with a high rate of symptomatic hardware and subsequent hardware removal. We proposed a method of intramedullary fixation using a specialized threaded pin. As this fixation is intramedullary, it avoids many of the problems associated with traditional surgical treatment methods for this fracture. We present a series of nine patients treated in this manner, all of whom had associated distal radius fractures. Preoperative and postoperative radiographs were reviewed, after which patients were contacted via phone. Patient-reported outcome measures, including QuickDASH and visual analog scale scores, were assessed. The average QuickDASH score was 13.6 (range, 0-100), with a median of 9.1. Three patients reported occasional ulnar-sided wrist pain, with an average visual analog scale score of 1.3 (range, 0-10) and a median of 0.5. All patients returned to all activities except one patient who could not resume playing musical instruments because of stiffness. No patient required removal of the threaded pin, but one patient underwent removal of the radial volar plate. No other patients underwent secondary procedures. Threaded pin fixation is a viable alternative to existing options for distal ulnar neck fractures and may have an advantage over plate fixation because of a lack of hardware prominence. Therapeutic IV.