scholarly journals Biodegradable magnesium screws in elbow fracture fixation: Clinical case series

2021 ◽  
pp. 221049172098698
Author(s):  
Wai-Him Lam ◽  
Chi-Yin Tso ◽  
Ning Tang ◽  
Wing-Hoi Cheung ◽  
Ling Qin ◽  
...  
Keyword(s):  
Case Series ◽  
Elbow Fracture ◽  
Normal Range ◽  
Head Region ◽  
Screw Head ◽  
Loss Of Reduction ◽  
Clinical Series ◽  
Post Operation ◽  
Bioabsorbable Screws ◽  
Biodegradable Magnesium

Biodegradable magnesium-based implants are innovative alternatives that potentially eliminate the need for implant removal. Recent studies have demonstrated the osteogenic properties and bacterial inhibition potentials of magnesium screws. We reported a clinical series of three elbow fracture cases, where magnesium screws were used in the treatment of one radial head and two capitellum fractures. Postoperative clinical courses were uneventful, and fracture healing occurred within 3 months. In all cases, radiolucencies were observed around implants especially in the screw head region at 2 months post-operation, but disappeared with consolidation at 1 year post-operation. All patients achieved near normal range of motion, minimal symptoms and good functional outcomes. No complication such as failure of fixation, loss of reduction, malunion or infection was seen. No implant revision or removal was necessary. Magnesium bioabsorbable screws are shown to be a viable option for these fractures.

Implementing a REBOA program outside of the ivory tower: initial case series and lessons learned at a community trauma center.

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
Jacob J Glaser ◽  
Adam Czerwinski ◽  
Ashley Alley ◽  
Michael Keyes ◽  
Valentino Piacentino ◽  
...  
Keyword(s):  
Acute Care ◽  
Trauma Center ◽  
Systolic Pressure ◽  
Case Series ◽  
Lessons Learned ◽  
Hospital Environment ◽  
Open Approach ◽  
Improvement Program ◽  
Clinical Series ◽  
Community Trauma

Background: REBOA has become an established adjunct to hemorrhage control. Prospective data sets are being collected, primarily from large, high volume trauma centers. There are limited data, and guidelines, to guide implementation and use outside of highly resourced environments. Smaller centers interested in adopting a REBOA program could benefit from closing this knowledge gap. Methods: A clinical series of cases utilizing REBOA from Grand Strand Medical Center, Myrtle Beach, South Carolina were reviewed. This represents early data from a busy community trauma center (ACS Level 2), from January 2017 to May 2018. Seven cases are identified and reported on, including outcomes. Considerations and ‘lessons learned’ from this early institutional experience are commented on.   Results: REBOA was performed by trauma and acute care surgeons for hemorrhage and shock (blunt trauma n=3, penetrating trauma n=2, no- trauma n=2). All were placed in Zone 1 (one initially was placed in zone 3 then advanced). Mean (SD) systolic pressure (mmHg) before REBOA was 43 (30); post REBOA pressure was 104 (19). N=4 were placed via an open approach, n=3 percutaneous (n=2 with ultrasound). All with arrest before placement expired (n=3) and all others survived. Complications are described.   Conclusions: REBOA can be a feasible adjunct for shock treatment in the community hospital environment, with outcomes comparable to large centers, and can be implemented by acute care and trauma surgeons. A rigorous process improvement program and critical appraisal process are critical in maximizing benefit in these centers.

O-Arm–Guided Balloon Kyphoplasty: Prospective Single-Center Case Series of 54 Consecutive Patients

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons250-ons256 ◽  
Author(s):  
Frédéric Schils
Keyword(s):  
Case Series ◽  
Balloon Kyphoplasty ◽  
Guidance System ◽  
Fluoroscopy Time ◽  
Vertebral Compression Fractures ◽  
Additional Time ◽  
Minimally Invasive Spinal Surgery ◽  
X Ray ◽  
Clinical Series ◽  
The Mean

Abstract Background: Balloon kyphoplasty is widely used to treat vertebral compression fractures. Procedure outcome and safety are directly linked to precise radiological imaging requiring 1 or 2 C arms to allow correct visualization throughout the procedure. This minimally invasive spinal surgery is associated with radiation exposure for both patient and surgeon. In our center, we switched from using a C-arm to an O-arm image guidance system to perform balloon kyphoplasty. Our preliminary experience is reported in Acta Neurochirurgica, and the encouraging results led us to study this subject more extensively. This article presents our complete results. To the best of our knowledge, there is no comparable clinical series describing O-arm use in kyphoplasty procedures published in the literature. Objective: To report our complete results of using the O-arm guidance system to perform balloon kyphoplasty. Methods: We prospectively evaluated O-arm–guided kyphoplasty procedure in 54 consecutive patients and measured x-ray exposure and fluoroscopy time. Results: The mean surgical time for the procedure was 38 minutes with a mean fluoroscopy procedure time of 3.1 minutes. The mean fluoroscopy time by level was 2.5 minutes. Mean irradiation dose by procedure was 220 mGy and by level was 166 mGy. There was a significant reduction in fluoroscopy time and x-ray exposure from 5.1 minutes with classic C-arm use to 3.1 minutes when with O-arm use without additional time required for positioning the system. Conclusion: With this new intraoperative system, the overall surgical and fluoroscopy times can be further reduced in the near future.

scholarly journals Applications of Medical Tattooing: A Systematic Review of Patient Satisfaction Outcomes and Emerging Trends

2021 ◽  
Author(s):  
Stacie J Becker ◽  
Jeffrey E Cassisi
Keyword(s):  
Patient Satisfaction ◽  
Medical Condition ◽  
Case Series ◽  
Outcome Data ◽  
Future Research ◽  
Health Service Provider ◽  
Level Of Evidence ◽  
Case Examples ◽  
Areola Complex ◽  
Clinical Series

Abstract Background Medical tattooing is often applied in the context of plastic, aesthetic, and reconstructive surgery to help achieve the best cosmetic outcome. Objectives This article reviews various conditions that medical tattooing have been empirically studied in terms of patient satisfaction outcomes; makes practice recommendations; and suggests future directions for research. Methods This review was performed following the PRISMA guidelines. Studies were included if the tattooing application was associated with a medical condition and if outcome data was provided using at least a case series methodology. Where no cohort or clinical series exist, case examples are used from the literature and the author’s practice to illustrate emerging medical tattooing applications that need further evaluation. Results Eighteen studies met the inclusion criteria and were applied to the following conditions: baldness, vitiligo, scars from incisions, lacerations or burns, and nipple areola complex reconstruction following breast surgery. Conclusions The application of medical tattooing has shown high levels of patient satisfaction across various conditions. The practice recommendation grade is “B” or recommend since the level of evidence for these interventions ranged from III to IV according to the ASPS guidelines. This means clinicians can consider this treatment alternative, but they should be alert to new information and be sensitive to patient preferences. Recommendations are made for reporting future research including clearly describing procedural details, identifying the professional performing the procedure, increased use of standardized outcome measures, and that satisfaction ratings be assessed by someone independent of the health service provider. Further research using RCT methodology with waitlist controls is needed.

scholarly journals Symptomatic Tarlov Cysts: an MRI evaluation of case series and literature review

2013 ◽  
Vol 4 (3) ◽  
pp. 35-42
Author(s):  
Netra Rana ◽  
Shao Hui Ma ◽  
Ming Zhang ◽  
Subesh Dahal ◽  
Zhi-Gang Min
Keyword(s):  
Cyst Wall ◽  
Nerve Root ◽  
Signal Intensity ◽  
Case Series ◽  
Treatment Method ◽  
Outcome Data ◽  
Hyperintense Signal ◽  
Tarlov Cysts ◽  
Post Operation ◽  
Histological Confirmation

Corrections: on Page 38 in the 4th line of text, the information in brackets (Figure 1, 2, 3a and 4) was replaced on 24th June 2013 with (Figure 1. 2 3b and 4). The number of the references has also been changed. The corrected PDF is available by clicking the link below.Aim: To analyze the characteristics of symptomatic Tarlov cysts by MRI. Materials and Methods: Neuroimaging and clinical outcome data were reviewed of 48 consecutive patients treated for symptomatic Tarlov cysts. All patients were scanned under Philips Gyroscan Intera 1.5T scanner with spinal surface coils. Two widely used surgical procedures were performed, 1) incision and drainage of the cyst with imbrication of the redundant nerve root sheath, and 2) exposure of the cyst, drainage of cyst contents, identification of nerve roots, and cyst wall resection combined with duraplasty. The post-operation follow-up was obtained from return visits to the neurosurgery and orthopaedic out-patient department or by telephone questionnaires. Results: All cystic lesions showed hypointense signal intensity on T1WI and hyperintense signal intensity on T2WI, but the nerve root showed iso-intensity on T1WI and low signal intensity on T2WI. They were linear in shape on sagittal view, and hypo intense dotted spots within the cysts on traverse view. Surrounding structures of the larger cysts were compressed and had bone erosions in some cases; the spinal canal and the intervertebral foramen on the affected side were enlarged. The lesions/cyst wall showed no enhancement after gadolinium administration. Conclusion: MRI will give a definite diagnosis of Tarlov cysts if nerve root presents within the cyst cavity or in the cyst wall; eliminating the need for histological confirmation. A correct analysis of the characteristics of symptomatic Tarlov cysts by MRI, will document its usefulness in noninvasive diagnosis and aid in exploration of the simplest treatment method. DOI: http://dx.doi.org/10.3126/ajms.v4i3.8056 Asian Journal of Medical Sciences 4(2013) 35-42

scholarly journals Pregnancy in acromegaly is safe and is associated with improvements in IGF-1 concentrations

2019 ◽  
Vol 180 (4) ◽  
pp. K21-K29 ◽  
Author(s):  
Anne Marie Hannon ◽  
Triona O’Shea ◽  
Claire A Thompson ◽  
Mark J Hannon ◽  
Rosemary Dineen ◽  
...  
Keyword(s):  
Case Series ◽  
Later Life ◽  
Reference Level ◽  
Somatostatin Analogue ◽  
Biochemical Control ◽  
Normal Range ◽  
Normal Limits ◽  
Age Related ◽  
Plasma Gh ◽  
Pituitary Macroadenomas

Pregnancy is rarely reported in acromegaly. Many patients are diagnosed in later life and younger patients may have subfertility due to hypopituitarism. We present a case series of 17 pregnancies in 12 women with acromegaly. Twelve women with acromegaly who completed pregnancy were identified from centres involved in the Irish Pituitary Study. Eleven women had pituitary macroadenomas and one woman had a microadenoma. Only 5/17 pregnancies had optimal biochemical control of acromegaly preconception, as defined by IGF-1 concentration in the age-related reference level and plasma GH concentration of <2 μg/L. In 6/17 pregnancies, dopamine agonist treatment was continued during pregnancy; all other acromegaly treatments were discontinued during pregnancy. Effect of pregnancy on acromegaly: No patient developed new visual field abnormalities, or symptoms suggestive of tumour expansion during pregnancy. In 9/12 patients, plasma IGF-1 concentrations that were elevated preconception normalised during pregnancy. There was a reduction in plasma IGF-1 concentrations, though not into the normal range, in a further two pregnancies. Effect of acromegaly on pregnancy: 15 healthy babies were born at term; one patient underwent emergency C-section at 32 weeks for pre-eclampsia, and one twin pregnancy had an elective C-section at 35 weeks’ gestation. Blood pressure remained within normal limits in the remainder of the pregnancies. Gestational diabetes did not develop in any pregnancy. Our data suggests that pregnancy in women with acromegaly is generally safe, from a maternal and foetal perspective. Furthermore, biochemical control tends to improve despite the withdrawal of somatostatin analogue therapy during pregnancy.

scholarly journals Sciatic neuropathy with preserved sensory nerve action potentials, a case series

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Matthew Ritch ◽  
Omer Suhaib ◽  
Yuebing Li
Keyword(s):  
Action Potentials ◽  
Sensory Nerve ◽  
Case Series ◽  
Normal Range ◽  
Single Institution ◽  
Lumbosacral Radiculopathy ◽  
Sciatic Neuropathy ◽  
Nerve Action ◽  
Sensory Nerve Action ◽  
Sensory Fibers

Background: Sciatic neuropathy is differentiated from lumbosacral radiculopathy based on the finding of abnormal sensory nerve action potentials (SNAPs). Cases of sciatic neuropathy with intact SNAPS have not been well described. Methods: A retrospective analysis of 12 patients with sciatic neuropathy in a single institution. Results: We describe 12 patients in whom a sciatic neuropathy was diagnosed based on a combination of history, physical exam, radiological and electrodiagnostic (EDX) findings. Lower extremity SNAPs were found to be within normal range in all patients, although SNAP amplitude asymmetry between both sides was observed in 3. Included patients were young (mean age of 40.3 years) and mostly female (9 patients). Conclusions: Sciatic neuropathy may occur with a relative sparing of sensory fibers. Recognition of this group of patients should help to avoid making a misdiagnosis of lumbosacral radiculopathy.

scholarly journals Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized controlled trial

2020 ◽  
Author(s):  
Michelle Seiler ◽  
Peter Heinz ◽  
Alessia Callegari ◽  
Thomas Dreher ◽  
Georg Staubli ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Range Of Motion ◽  
Daily Life ◽  
Controlled Trial ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Normal Range ◽  
Randomized Controlled ◽  
Loss Of Reduction ◽  
Distal Forearm Fractures

Abstract Purpose The aim of this study was to investigate whether short-arm fiberglass cast (SAC) immobilization provides fracture stabilization comparable to that of long-arm cast (LAC) treatment of displaced distal forearm fractures after closed reduction in paediatric patients. Methods A prospective, randomized, controlled trial of children aged four to 16 years (mean 9.9 years) was designed with a sample of 120 children, whose size was set a priori, with 60 treated with SAC and 60 with LAC. The primary outcome was fracture stability and rate of loss of reduction. The secondary outcome analysis evaluated duration of analgesic therapy, restriction in activities of daily life, and the duration until patients regained normal range of motion in the elbow. Results No statistically significant differences were found between the two groups in loss of reduction or duration of analgesic therapy. In contrast, the duration until normal range of motion in the elbow was regained was significantly longer in the LAC group (median 4.5 days, P < 0.001). Restriction in activities of daily life did not differ significantly between the two groups except for the item “help needed with showering in the first days after trauma” (SAC 60%, LAC 87%, P = 0.001). Conclusion Fracture immobilization with short-arm fiberglass cast in reduced distal forearm fractures is not inferior to long-arm casts in children four years and older, excluding completely displaced fractures. Furthermore, short-arm casting reduces the need for assistance during showering. Trial registration NCT03297047, September 29, 2017

Injection Laryngoplasty for the Treatment of Type 1 Laryngeal Clefts: A Single Institution Experience

2020 ◽  
pp. 000348942097323
Author(s):  
Mohammad Al-Alawneh ◽  
Ladd Caballero ◽  
Elijah DeBroux ◽  
Michael J. Herr ◽  
Amy Claire Petro ◽  
...  
Keyword(s):  
Case Series ◽  
Secondary Outcome ◽  
Injection Laryngoplasty ◽  
Single Institution ◽  
Retrospective Case ◽  
Swallowing Function ◽  
Post Operation ◽  
Gel Injection ◽  
Number Of Injections

Objective: Standards for treatment of laryngeal clefts remain poorly defined. There are no large case series that report the efficacy of injection laryngoplasty (IL) in the treatment of pediatric Type 1 laryngeal clefts (LC-1). The objective of this study is to measure the effect of IL in young children with LC-1. Methods: A retrospective case series of 130 patients was completed over 3 years at a at a single institution included patients aged 1 month to 8 years, diagnosed with aspiration and penetration issues during swallowing based on a Videofluoroscopic Swallow Study (VFSS). Patients underwent surgical evaluation and intervention using carboxymethylcellulose gel injection. Collected data points included age in months at time of first injection, gender, race, pre- and post-operation VFSS scores, number of injections, co-morbidities and post-operative complications. VFSS scores were evaluated pre- and post-operatively to assess efficacy of intervention. A secondary outcome was efficacy in patients with aspiration compared to those with penetration alone. Results: This study included 77 male and 53 female patients. Sixty-two patients (48%) demonstrated a significant post-operative improvement in their swallowing function ( P < .05). There were no statistical differences in age, number of injections, or the volume of the first injection. Patients that showed a post-operative improvement in swallowing function were on average 5 months older and had more severe aspiration and penetration compared to those who did not demonstrate a post-operative benefit and underwent less injections. The volume of injection did not appear to play a role in the success rate. Conclusion: Injecting the inter-arytenoid area in patients with LC-1 appears to confer some benefit to close to half of our patient population. Successful procedures seemed to occur in patients with more severe aspiration and penetration and older age.

Complete Abolition of Opioid Prescribing in an Upper Extremity Surgical Practice

Hand ◽  
2020 ◽  
pp. 155894472096671
Author(s):  
Mark Henry
Keyword(s):  
Soft Tissue ◽  
Upper Extremity ◽  
Pain Control ◽  
Case Series ◽  
Similar Efficacy ◽  
Wound Management ◽  
Elbow Fracture ◽  
Level Of Evidence ◽  
Hand Fracture ◽  
Fracture Bone

Background Prescription opioids threaten potential addiction, diversion, and death. Nonopioid regimens have demonstrated similar efficacy for select upper extremity postoperative patients. Methods After adopting a practice policy completely abolishing opioid prescriptions, data were collected on all consecutive surgical cases for the next 6 months, without exclusion. There were 800 cases, 61% male and 39% female, with a mean age of 45. Seventy patients (9%) reported already using prescription medications employed in multimodality regimens; no instruction was given to alter consumption. Patients were divided into 5 groups based on the type of surgery: elective soft tissue (24%), trauma wound management (19%), soft tissue structural repairs (9%), hand fracture/bone procedures (34%), and wrist to elbow fracture/bone procedures (14%). Each group was compared directly to each other group with a 2-tailed t-test, P < .05. Results Patients reported achieving pain control without the need for further medication assistance by a mean of postoperative day 2.7. Times to pain control by group were as follows: 1.5, 3.1, 2.7, 2.9, and 3.6 days respectively. Mean postoperative daily pain scores (using a 10-point visual analog scale) for days 1 to 5 were as follows: 2.8, 2.1, 1.5, 1.0, and 0.6, respectively, with a sum of 8.0. During the 6-month tracking period, the practice only received 4 calls from patients with questions about pain control (0.5% of cases). Conclusions Patients achieved good immediate pain control without opioids and reported rapidly declining pain levels over the next several days to the point of no longer requiring medication. Type of Study/Level of Evidence Prospective cohort case series, therapeutic; Level IV.

Hypoprolactinaemic galactorrhoea in long-term methadone treatment

2011 ◽  
Vol 28 (2) ◽  
pp. 100-102
Author(s):  
Chimdi Uhoegbu ◽  
Michael Doran ◽  
John O'Connor
Keyword(s):  
Methadone Maintenance ◽  
Methadone Treatment ◽  
Nipple Discharge ◽  
Case Series ◽  
Endocrine System ◽  
Serum Prolactin ◽  
Hiv Positive ◽  
Normal Range ◽  
Breast Lumps

AbstractAlthough hyperprolactinaemia is associated with galactorrhoea, galactorrhoea often occurs without any hyperprolactinaemia. This has been well established, and it has been documented in women prescribed/using methadone and other opiates. One case series described amenorrhoea and galactorrhoea in ‘female heroin addicts’, but it has not before been described in a patient with hypoprolactinaemia.We report a case of a 30 year old non-pregnant, non-puerperal, opioid-dependent, HIV positive woman on long-term methadone maintenance programme, who presented with bilateral, milky nipple discharge, associated with painful breast lumps, but with serum prolactin levels below the normal range. She was not prescribed any other medications likely to have effect on the endocrine system. This case highlights the need for prescribers to be alert to the implications of long-term use of opioids.

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