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Injury Dec 2015Vascular injuries (VI) presenting during internal fixation (IF) of proximal femoral fractures (PFF) are potentially limb- and life-threatening. The purpose of this... (Review)
Review
INTRODUCTION
Vascular injuries (VI) presenting during internal fixation (IF) of proximal femoral fractures (PFF) are potentially limb- and life-threatening. The purpose of this systematic review of the literature is to report on their incidence, associated complications and to give special emphasis in their prevention.
MATERIALS AND METHODS
A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of VIPFF-IF and series of PFF-IF with cases of VI published between inception of journals to March 2015 were eligible for inclusion. Relevant information was divided in two parts. Part I included the analysis of cases of VIPFF-IF, with the objective of establishing the frequency of injury of each vessel, the types and mechanisms of injury, the diagnostic and therapeutic modalities, and the outcomes. Part II analysed series of PFF-IF, which included case(s) of VI for assessing the incidence of VIPFF-IF.
RESULTS
Overall 160 articles with 182 cases of VIPFF-IF met the inclusion criteria. The injuries to extrapelvic vessels prevailed over those of intrapelvic vessels. There was a higher frequency of injury to the deep femoral artery and its branches in extrapelvic vessels and of external iliac artery and vein in intrapelvic vessels. The types of injury were: compression, intimal flap tear, disruption of the intimal layer with thrombosis, laceration with haemorrhage, and puncture or progressive erosion leading to a pseudoaneurysm (PSA) or arteriovenous fistula (AVF), with high prevalence for PSA, followed by lacerations. PSAs were more frequent in extrapelvic lesions and lacerations in the intrapelvic vessels. There were 7 non-iatrogenic injuries, produced by a displaced lesser trochanter fragment or other bone fragments, and 175 iatrogenic injuries (96.15%). The intrapelvic intraoperative protrusion of instruments or implants, or the post-operative migration of implants produced the injuries of intrapelvic vessels. For iatrogenic injuries of extrapelvic vessels the prevalent mechanism was a displaced lesser trochanter fragment, either intra- or postoperatively, followed by injuries by an overshot drill bit or a protruding screw; several other mechanisms completed the list. The clinical and radiological investigations were similar to those of VI elsewhere. VI occurred either at the time of fracture, during surgery or after it, early or late, weeks, months or even years after IF. The diagnostic and therapeutic modalities were most diverse, and the incidence of morbidity and mortality was 18.06%. The overall incidence of VIPFF-IF was 0.49%.
CONCLUSION
The incidence of VIPFF-IF is low, though it will probably rise because of the increasing frequency of PFF. With few exceptions, these injuries, which are potentially limb and life-threatening, are iatrogenic, resulting of errors in IF, with different types of lesions to intra- and extrapelvic vessels running in close proximity to the bone. Although the surgeon should bear in mind this possibility and achieve early diagnosis and prompt accurate treatment, there is no consensus as to what is the best diagnostic or therapeutic modality. A precise diagnosis of the preoperative vascular status of the limb, monitoring of the displacement of the lesser trochanter fragment, careful and gentle reduction of the fracture, and precise handling of instruments and implant selection and placement during IF, are factors to consider in order to prevent this complication, which should never be underestimated.
Topics: Bone Screws; Femoral Artery; Femoral Fractures; Fracture Fixation, Internal; Humans; Iatrogenic Disease; Iliac Artery; Incidence; Lacerations; Leg; Patient Selection; Postoperative Complications; Practice Guidelines as Topic; Reoperation; Treatment Outcome
PubMed: 26521991
DOI: 10.1016/j.injury.2015.10.021 -
The Cochrane Database of Systematic... May 2019Keratoconus is a degenerative condition of the cornea that profoundly affects vision and vision-specific quality of life. The axial cornea thins and protrudes, resulting...
BACKGROUND
Keratoconus is a degenerative condition of the cornea that profoundly affects vision and vision-specific quality of life. The axial cornea thins and protrudes, resulting in irregularity and, eventually, scarring of the cornea. There are multiple options available for treating keratoconus. Intrastromal corneal ring segments are small, crescent-shaped plastic rings that are placed in the deep, peripheral corneal stroma in order to flatten the cornea. They are made of polymethylmethacrylate (PMMA). The procedure does not involve corneal tissue nor does it invade the central optical zone. Intrastromal corneal ring segments are approved for use when contact lenses or spectacles are no longer adequate.
OBJECTIVES
To evaluate the effectiveness and safety of intrastromal corneal ring segments as a treatment for keratoconus.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 1); Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Health Sciences Literature Database (LILACS); ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not implement any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 25 January 2018.
SELECTION CRITERIA
Two review authors independently assessed records from the electronic searches to identify randomized controlled trials (RCTs). Disagreements were resolved by discussion.
DATA COLLECTION AND ANALYSIS
We planned for two authors to independently review full-text reports, using standard methodological procedures expected by Cochrane.
MAIN RESULTS
We found no RCTs comparing intrastromal corneal ring segments with spectacles or contact lenses.
AUTHORS' CONCLUSIONS
In the absence of eligible RCTs to review, no conclusions can be drawn.
Topics: Corneal Stroma; Corneal Transplantation; Humans; Keratoconus; Prostheses and Implants; Prosthesis Implantation
PubMed: 31087649
DOI: 10.1002/14651858.CD011150.pub2 -
Journal of Gambling Studies Dec 2023Problem gambling not only impacts gamblers but also protrudes onto several affected others who experience adverse impacts, including financial, health, relationships,... (Meta-Analysis)
Meta-Analysis Review
Problem gambling not only impacts gamblers but also protrudes onto several affected others who experience adverse impacts, including financial, health, relationships, and psychological problems. The aims of this systematic review were twofold; to identify the psychosocial interventions to minimise the harm caused to affected others of problem gambling and to assess their efficacy. This study was conducted as outlined in the research protocol PROSPERO (CRD42021239138). Database searches were conducted in CENTRAL, MEDLINE, Social Science Database, CINHAL Complete, Academic Search Ultimate and PsycINFO. Randomised controlled trials of psychosocial interventions that aimed to minimise the harm caused to affected others of problem gambling written in English were eligible for inclusion. Risk of bias for included studies was assessed using the Cochrane ROB 2.0 tool. The identified interventions focused on two approaches to supporting affected others: interventions involving both the problem gambler and affected others, and interventions involving affected others only. As the interventions and outcome measures used were sufficiently similar, a meta-analysis was conducted. The quantitative synthesis revealed that generally, treatment groups were unable to show greater benefits over control groups. The goal for future interventions aimed at affected others of problem gambling should focus primarily on the wellbeing of affected others. The standardisation of outcome measures and data collection time points for better comparison of future research is needed.
Topics: Humans; Gambling; Psychosocial Intervention
PubMed: 37294395
DOI: 10.1007/s10899-023-10220-3 -
The Journal of Craniofacial SurgeryBilateral cleft lip and palate (BCLP) remains a difficult surgical problem due to the severely protruding premaxillary segment, with no consensus of optimal treatment...
BACKGROUND
Bilateral cleft lip and palate (BCLP) remains a difficult surgical problem due to the severely protruding premaxillary segment, with no consensus of optimal treatment sequence in older patients. A systematic review of the literature was performed to assess the current status of BCLP repair based on age.
METHODS
A PRISMA systematic review of the PubMed, Web of Science, and Embase databases was performed using a series of search terms related to BCLP. Studies were categorized based on the age of presentation, repair sequence, and technique.
RESULTS
The database search identified 381 articles. Of these, 72 manuscripts were ultimately included. The lip was repaired first in 1077 patients (86.0%), palate first in 161 patients (12.9%), and simultaneous lip and palate in 14 patients (1.1%). Patients less than 6 months old received lip repair first (n = 959, 98.6%), with complications of unaesthetic appearance (n = 86, 62.3%) and midface retrusion (n = 41, 34.1%) in younger patients and wound dehiscence (n = 8, 40%) in older patients. Primary lip repair was preceded by presurgical orthopedics (n = 760) or lip adhesion (n = 272) to reduce lip tension with nasoalveolar molding (n = 452, 62.9%) or the Latham device (n = 282, 37.1%). In older patients, the palate was repaired first or premaxillary setback (n = 222) was indicated in protruded premaxillae greater than 10 mm, but carried the risk of premaxilla mobility (n = 20, 37.7%) and midface retrusion (n = 10, 18.9%).
CONCLUSION
In younger patients, lip repair is performed first with preoperative orthopedics or lip adhesion. In older patients, the palate is more commonly repaired first compared with the lip; however, there is no difference in complication rate.
Topics: Aged; Cleft Lip; Cleft Palate; Humans; Infant; Maxilla
PubMed: 34560740
DOI: 10.1097/SCS.0000000000008184 -
Journal of Personalized Medicine Apr 2022Wireless capsule endoscopy allows the identification of small intestinal protruded lesions, such as polyps, tumors, or venous structures. However, reading wireless... (Review)
Review
BACKGROUND
Wireless capsule endoscopy allows the identification of small intestinal protruded lesions, such as polyps, tumors, or venous structures. However, reading wireless capsule endoscopy images or movies is time-consuming, and minute lesions are easy to miss. Computer-aided diagnosis (CAD) has been applied to improve the efficacy of the reading process of wireless capsule endoscopy images or movies. However, there are no studies that systematically determine the performance of CAD models in diagnosing gastrointestinal protruded lesions.
OBJECTIVE
The aim of this study was to evaluate the diagnostic performance of CAD models for gastrointestinal protruded lesions using wireless capsule endoscopic images.
METHODS
Core databases were searched for studies based on CAD models for the diagnosis of gastrointestinal protruded lesions using wireless capsule endoscopy, and data on diagnostic performance were presented. A systematic review and diagnostic test accuracy meta-analysis were performed.
RESULTS
Twelve studies were included. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD models for the diagnosis of protruded lesions were 0.95 (95% confidence interval, 0.93-0.97), 0.89 (0.84-0.92), 0.91 (0.86-0.94), and 74 (43-126), respectively. Subgroup analyses showed robust results. Meta-regression found no source of heterogeneity. Publication bias was not detected.
CONCLUSION
CAD models showed high performance for the optical diagnosis of gastrointestinal protruded lesions based on wireless capsule endoscopy.
PubMed: 35455760
DOI: 10.3390/jpm12040644 -
Sleep Medicine Nov 2020While obstructive sleep apnea (OSA) is associated with several chronic health conditions such as hypertension, obesity, and chronic hypoxia, there is limited information... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
While obstructive sleep apnea (OSA) is associated with several chronic health conditions such as hypertension, obesity, and chronic hypoxia, there is limited information on its association with neuromuscular and spinal pathologies that may be of interest to a musculoskeletal (MSK) medicine or pain management clinician. The objective of this study was to perform a systematic literature review to examine the association between OSA and cervical spine pathologies, postural changes, and pain.
DESIGN
We systematically reviewed PubMed and Embase databases up to 4/15/2019. We included studies that explored associations between OSA and a) pain, b) postural characteristics or changes, or c) cervical spine morphology. Systematic reviews, meta-analysis, randomized control trials, cohort studies, and case-control studies were included. Case reports, narrative reviews or expert opinion papers were excluded. From the articles that met selection criteria, information regarding type, direction and magnitude of such associations was extracted. The OSA-pain association studies were further divided into 3 subgroups: neuropathic, temporomandibular, and chronic pain.
RESULTS
21 articles that met our study criteria were selected for this review. Two studies were on cervical spine pathologies, eight on postural changes, and eleven on pain associated with OSA. Exploring the association between OSA and cervical spine pathologies, postural changes, and pain in this systematic review we found: (1) Cervical spine lesions, fusions, and abnormalities that reduce retropharyngeal space are associated with OSA, likely by way of worsening posture and decreasing range of motion. (2) Head extension and anteriorization are associated with OSA likely as a compensatory mechanism. Extension may improve airway function, while anteriorization helps to maintain visual sense. (3) Head-of-bed-elevation may improve OSA symptoms and can possibly supplement other conservative treatment measures. (4) Neuropathic pain is associated with OSA, likely by way of inflammatory pathways. (5) Oral appliance use (eg mandibular advancement/protruding device) in OSA likely contributes to transient temporomandibular pain. (6) There is little association between OSA and chronic pain prevalence. (7) Increased pain intensity and decreased pain tolerance are somewhat associated with OSA, likely by way of hypoxemia and sleep fragmentation.
CONCLUSIONS
Clinicians in MSK and pain medicine need to consider these associations and consider obtaining imaging studies and/or making referrals for management of their OSA to better provide appropriate care to these patients.
Topics: Cervical Vertebrae; Chronic Pain; Humans; Posture; Respiratory System; Sleep Apnea, Obstructive
PubMed: 33007717
DOI: 10.1016/j.sleep.2020.09.008 -
Journal of Periodontology Jun 2017This systematic review and meta-analysis aims to investigate survival rates of dental implants placed simultaneously with graft-free maxillary sinus floor elevation... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review and meta-analysis aims to investigate survival rates of dental implants placed simultaneously with graft-free maxillary sinus floor elevation (GFSFE). Factors influencing amount of vertical bone gain (VBG), protruded implant length (PIL) in sinus at follow-up (PILf), and peri-implant marginal bone loss (MBL) are also evaluated.
METHODS
Electronic and manual searches for human clinical studies on simultaneous implant placement and GFSFE using the lateral window or transcrestal approach, published in the English language from January 1976 to March 2016, were conducted. The random-effects model and mixed-effect meta-regression were used to analyze weighted mean values of clinical parameters and evaluate factors that influenced amount of VBG.
RESULTS
Of 740 studies, 22 clinical studies were included in this systematic review. A total of 864 implants were placed simultaneously with GFSFE at edentulous sites having mean residual bone height of 5.7 ± 1.7 mm. Mean implant survival rate (ISR) was 97.9% ± 0.02% (range: 93.5% to 100%). Weighted mean MBL was 0.91 ± 0.11 mm, and it was significantly associated with the postoperative follow-up period (r = 0.02; R = 43.75%). Weighted mean VBG was 3.8 ± 0.34 mm, and this parameter was affected significantly by surgical approach, implant length, and PIL immediately after surgery (PILi) (r = 2.82, 0.57, 0.80; R = 19.10%, 39.27%, 83.92%, respectively). Weighted mean PILf was 1.26 ± 0.33 mm (range: 0.3 to 2.1 mm).
CONCLUSION
Within limitations of the present systematic review, GFSFE with simultaneous implant placement can achieve satisfactory mean ISR of 97.9% ± 0.02%.
Topics: Humans; Alveolar Bone Loss; Databases, Factual; Dental Implantation, Endosseous; Dental Implants; Dental Restoration Failure; Maxilla; Maxillary Sinus; Michigan; Sinus Floor Augmentation
PubMed: 28168901
DOI: 10.1902/jop.2017.160665 -
Injury Dec 2016The induced membrane technique was designed by Masquelet et al. to address segmental bone defects of critical size in adults. It has been used after bone defects of... (Review)
Review
The induced membrane technique was designed by Masquelet et al. to address segmental bone defects of critical size in adults. It has been used after bone defects of traumatic, infectious and tumoral origin with satisfactory results. Recently, it has been used in children but, after an initial enthusiasm, several cases of failure have been reported. The purpose of this study was to assess the success rate and the risk factors of failure of the induced membrane for children. We conducted a systematic review of all the studies reporting the results of the induced membrane technique to address bone defects of critical size in children. Our primary outcome was the success rate of the technique defined as a bone union before any iterative surgery. Our secondary outcomes were the complications and the risk factors of failure. We searched Medline via Pubmed, EMBASE and the Cochrane Library. Twelve studies, including 69 patients, met the inclusion criteria. There were 41 boys and 28 girls. Mean age at surgery was 10 years. Mean size of resection was 12.38 cm and the mean time between the two stages was 5.86 months. Mean rate of bone union after the two stages of the induced membrane technique was 58% (40/69) but this rate increased to 87% after revision surgeries (60/69). Main complications were non-unions (19/69), lysis of the graft (6/69) and fractures of the bone graft (6/69). Only 1/69 deep infection was reported. Other non specific complications were regularly reported such limb length discrepancies, joint stiffness and protruding wires. Risk factor of failure that could be suspected comprised the resection of a malignant tumour, a bone defect located at the femur, a wide resection, a long time between the two stages, an unstable osteosynthesis and a bone graft associating autograft to other graft materials. The induced membrane technique is suitable for bone defects of critical size in children. It is a reliable technique with no need of micro vascular surgery. However, we found several risk factors of failure for the use of the induced membrane technique to address segmental bone defect of critical size in children.
Topics: Bone Neoplasms; Bone Transplantation; Fibula; Fracture Fixation, Internal; Fractures, Bone; Humans; Osteosarcoma; Plastic Surgery Procedures; Risk Factors; Treatment Outcome
PubMed: 28040089
DOI: 10.1016/S0020-1383(16)30841-5 -
Journal of Clinical Sleep Medicine :... Oct 2016To perform a review of the current evidence regarding the use of a remotely controlled mandibular positioner (RCMP) and to analyze the efficacy of RCMP as a predictive... (Review)
Review
The Use of Remotely Controlled Mandibular Positioner as a Predictive Screening Tool for Mandibular Advancement Device Therapy in Patients with Obstructive Sleep Apnea through Single-Night Progressive Titration of the Mandible: A Systematic Review.
STUDY OBJECTIVES
To perform a review of the current evidence regarding the use of a remotely controlled mandibular positioner (RCMP) and to analyze the efficacy of RCMP as a predictive selection tool in the treatment of obstructive sleep apnea (OSA) with oral appliances that protrude the mandible (OAm), exclusively relying on single-night RCMP titration.
METHODS
An extensive literature search is performed through PubMed.com, Thecochranelibrary.com (CENTRAL only), Embase.com, and recent conference meeting abstracts in the field.
RESULTS
A total of 254 OSA patients from four full-text articles and 5 conference meeting abstracts contribute data to the review. Criteria for successful RCMP test and success with OAm differed between studies. Study populations were not fully comparable due to range-difference in baseline apneahypopnea index (AHI). However, in all studies elimination of airway obstruction events during sleep by RCMP titration predicted OAm therapy success by the determination of the most effective target protrusive position (ETPP). A statistically significant association is found between mean AHI predicted outcome with RCMP and treatment outcome with OAm on polysomnographic or portable sleep monitoring evaluation (p < 0.05).
CONCLUSIONS
The existing evidence regarding the use of RCMP in patients with OSA indicates that it might be possible to protrude the mandible progressively during sleep under poly(somno)graphic observation by RCMP until respiratory events are eliminated without disturbing sleep or arousing the patient. ETPP as measured by the use of RCMP was significantly associated with success of OAm therapy in the reported studies. RCMP might be a promising instrument for predicting OAm treatment outcome and targeting the degree of mandibular advancement needed.
Topics: Equipment Design; Humans; Mandible; Mandibular Advancement; Polysomnography; Predictive Value of Tests; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 27568892
DOI: 10.5664/jcsm.6202 -
Journal of Cardiovascular Medicine... Jun 2024Percutaneous coronary intervention (PCI) on severely calcified coronary lesions is challenging. Coronary calcified nodule (CN) refers to an eccentric and protruding... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Percutaneous coronary intervention (PCI) on severely calcified coronary lesions is challenging. Coronary calcified nodule (CN) refers to an eccentric and protruding coronary calcification associated with plaque vulnerability and adverse clinical events. This study aims to conduct an extensive review of CNs, focusing on its prognostic impact in comparison with nonnodular coronary calcification (N-CN).
METHOD
A systematic literature review on PubMed, MEDLINE, and EMBASE databases was conducted for relevant articles. Observational studies or randomized controlled trials comparing CNs and N-CNs were included.
RESULTS
Five studies comparing CNs and N-CNs were pertinent for inclusion. The total number of individuals across these studies was 1456. There were no significant differences in the baseline demographic, clinical, and angiographic data between the CN and N-CN groups. Intracoronary imaging was always utilized. At follow-up, CNs were associated with significantly increased, target vessel revascularization [odds ratio (OR) 2.16; 95% confidence interval (CI): 1.39-3.36, P-value < 0.01, I2 = 0%] and stent thrombosis (OR 9.29; 95% CI: 1.67-51.79, P-value = 0.01, I2 = 0%) compared with N-CN. A trend for greater cardiac death was also assessed in the CN group (OR 1.75; 95% CI: 0.98-3.13, P-value = 0.06, I2 = 0%).
CONCLUSION
CN has a significantly negative impact on outcomes when compared with N-CN.
Topics: Humans; Coronary Artery Disease; Vascular Calcification; Percutaneous Coronary Intervention; Risk Factors; Coronary Angiography; Treatment Outcome; Male; Female; Middle Aged; Risk Assessment; Aged
PubMed: 38818813
DOI: 10.2459/JCM.0000000000001625