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Brain & Spine 2024Orbital pathologies requiring surgery are traditionally treated by open approach with different techniques depending on the lesion location. Recently, minimally invasive...
INTRODUCTION
Orbital pathologies requiring surgery are traditionally treated by open approach with different techniques depending on the lesion location. Recently, minimally invasive endoscopic approaches, such as the Endoscopic Endonasal Approach (EEA) and the Endoscopic Transorbital Approach (ETA) have been introduced in orbital surgery.
RESEARCH QUESTION
The purpose of this study is to report the combined experience of the Neurosurgical and Ear-Nose-Throat (ENT) Units in the endoscopic approach of orbital pathologies.
MATERIAL AND METHODS
We retrospectively retrieved data on patients treated at our Institution between 2016 and 2021 with endoscopic approach for orbital pathologies. The Clavien-Dindo classification and the Scar Cosmesis Assessment and Rating (SCAR) Scale have been used to assess complications and cosmetic outcomes.
RESULTS
39 patients met the inclusion criteria. EEA (15 patients) or ETA (20 patients) were chosen to approach the lesions. In three cases we used a combination of endoscopic and anterior orbitotomy and in one patient a combination of EEA + ETA. The type of procedure performed was orbital biopsy (9 cases), orbital decompression (6 cases), subtotal resection of the lesion (STR) (8 cases) and total resection of the lesion (GTR) (16 cases). The more frequent postoperative complications were diplopia (5.1%, with 1 case of permanent diplopia), trigeminal paraesthesia and dysesthesia (5.1%), palpebral edema (17.9%), periorbital ecchymosis (7.7%). Mean follow up time was 21 months (range 2-63 months).
DISCUSSION AND CONCLUSION
Endoscopic approaches to orbital compartments provide minimally invasive access to every orbital compartment with low complications rate and good cosmetic outcome.
PubMed: 38510598
DOI: 10.1016/j.bas.2024.102770 -
Cureus Nov 2023Cuboid dislocations are a rare type of injury with few cases reported. A 41-year-old female came in for an assessment of her left foot, seeking evaluation 13 days...
Cuboid dislocations are a rare type of injury with few cases reported. A 41-year-old female came in for an assessment of her left foot, seeking evaluation 13 days post-injury. On inspection of the left lower extremity, we found swelling and ecchymosis throughout the midfoot. There was dimpling along the fourth/fifth tarsometatarsal (TMT) joint with palpable dorsal subluxation. A closed cuboid reduction with percutaneous pinning was performed 20 days after the initial injury. The cuboid was reduced with a combination of traction and direct pressure. One 1.6 mm Kirschner wire was passed from the fifth metatarsal across the TMT joint into the cuboid. At the 10-week follow-up appointment, she was ambulating with her boot and had successfully returned to work as a teacher. Radiographs demonstrated a maintained reduction of the dislocation and interval healing of the navicular and fourth metatarsal base fractures. Dislocations of the cuboid have only a handful of cases reported. They can occur in isolation or with other injuries of the midfoot. This patient was successfully treated with closed reduction and percutaneous pinning. Further studies are required to obtain a consensus on optimal treatment for these types of injuries.
PubMed: 38111424
DOI: 10.7759/cureus.49023 -
Journal of Feline Medicine and Surgery Apr 2024This case series describes the clinical findings and surgical intervention of 86 declawed cats; 52 from a shelter or rescue and 34 owned cats. Historical reports from...
CASE SERIES SUMMARY
This case series describes the clinical findings and surgical intervention of 86 declawed cats; 52 from a shelter or rescue and 34 owned cats. Historical reports from owners and shelter staff included house-soiling, biting behavior, repelling behavior, barbering, lameness, chronic digit infection and nail regrowth. All the cats had fragments of the third phalanx (P3) of varying sizes diagnosed on radiographs. Pathology visible on examination included digital subcutaneous swelling, ecchymosis, malaligned digital pads, ulcerations, exudate, tendon contracture, nail regrowth and callusing. Surgery was pursued in these cases to remove the P3 fragments, relieve tendon contracture and reposition the digital pads with an anchoring suture. Gross findings intraoperatively included fragmented growth of cornified and non-cornified nail tissue, osteophytes on the surface of the second phalanx, deep digital flexor tendon calcification, and both bacterial and sterile exudate. The most common complication 14 days postoperatively was mild (14%) to moderate (1%) lameness. All historical parameters recorded improved in both populations of cats (house-soiling, biting behavior, repelling behavior, barbering, lameness, tendon contracture and chronic digit infection). Postoperatively, 1/47 cats exhibited continued malalignment of two digital pads and there were no reports of long-term postoperative lameness.
RELEVANCE AND NOVEL INFORMATION
Two methods of declawing cats are detailed in the veterinary literature, including partial amputation of P3 and disarticulation of the entire P3 bone. The novel information in this report includes historical and clinical signs of declawed cats with P3 fragments, intraoperative gross pathology, surgical intervention and the postoperative follow-up results.
Topics: Animals; Cats; Cat Diseases; Male; Female; Hoof and Claw; Lameness, Animal; Fractures, Bone
PubMed: 38660961
DOI: 10.1177/1098612X241240331 -
Chirurgia (Bucharest, Romania : 1990) Feb 2024This study presents a comparative analysis of cryostripping to conventional saphenectomy. The study included 2191 patients admitted in the Phlebology Department, 1st...
This study presents a comparative analysis of cryostripping to conventional saphenectomy. The study included 2191 patients admitted in the Phlebology Department, 1st Surgical Department, Emergency County Hospital Timisoara, between September 2013 and April 2023, between September 2013 and April 2023, who underwent saphenectomy by cryostripping (1327 patients) or conventionally (864 patients). We compared the duration and costs of the procedure, hospitalization period, post-operative results, method feasibility, as well as the technical advantages of cryostripping compared to conventional surgery. A smaller proximal incision, compared to the classic operation, as well the fact that distal counter incision is not necessary, represents technical advantages of this procedure. Average duration of the intervention was 41 +- 12.8 minutes, consumables costs were about 52 +- 10 EUR/intervention, with an average hospitalization period was 1.05 +- 0.41 days. The post-operative results were favourable, early complications rate being reduced (ecchymoses Phi; 2 cm - 33.23%; hematoma - 2.11%; deep vein thrombosis - 0.15%; transient paresthesias 3.01%). Compared to classic saphenectomy, the costs of consumables/intervention are similar, intervention time, hospitalization period and complication rate being statistically significantly lower. An advantage of the method is the fact that the cryo-probes can be sterilized, being reusable; from the economic point of view, the technique perfectly fits in both public hospitals and private clinics. Cryostripping is a radical surgical procedure which bring a significant number of advantages compared to the classic saphenectomy, being an effective alternative in CVD treatment.
Topics: Humans; Treatment Outcome; Retrospective Studies; Saphenous Vein
PubMed: 38465716
DOI: 10.21614/chirurgia.2024.v.119.i.1.p.56 -
Clinics and Practice Aug 2023The aging process starts in the center of the face, in the periocular region and around the mouth, with a combination of volume loss, tissue descent, deepened wrinkles,...
BACKGROUND
The aging process starts in the center of the face, in the periocular region and around the mouth, with a combination of volume loss, tissue descent, deepened wrinkles, and the loss of skin structure and quality. Recently, several studies have demonstrated the efficacy of therapies based on autologous adipose tissue grafting, which leverages the properties of stromal vascular fraction (SVF) and adipose-derived mesenchymal stem cells (ADSCs) to accelerate the regenerative processes of the skin. This study aims to verify the ability of guided superficial enhanced fluid fat injection (SEFFI) in the facial area to correct volume loss and skin aging, proving that this standardized procedure has a very low rate of complications.
METHODS
We retrospectively collected data from 2365 procedures performed in Italian centers between 2019 and 2021. Guided SEFFI was performed alone or combined with cosmetic treatments, including the use of hyaluronic acid filler, suspension threads, synthetic calcium hydroxylapatite, botulin toxin, and microneedling.
RESULTS
guided SEFFI was used alone in more than 60% of the patients and in all facial areas. In about one-tenth of the patients, guided SEFFI was combined with a botulin toxin treatment or hyaluronic acid filling. Other procedures were used more rarely. Ecchymosis in the donor or injection sites was the most frequent adverse event but was only observed in 14.2% and 38.6% of the patients, respectively.
CONCLUSIONS
The guided SEFFI technique is standardized and minimally invasive, leading to very few complications. It constitutes a promising antiaging medical treatment that combines effectiveness, safety, and simplicity.
PubMed: 37623266
DOI: 10.3390/clinpract13040085 -
Journal of Caring Sciences Sep 2023Episiotomy is a usual midwifery surgery. Iran is a country with an abundant source of medicinal plants. This study aimed to investigate ginger extract ointment's effects...
INTRODUCTION
Episiotomy is a usual midwifery surgery. Iran is a country with an abundant source of medicinal plants. This study aimed to investigate ginger extract ointment's effects on the pain and recovery of episiotomy incisions in nulliparous women.
METHODS
This randomized clinical trial was conducted in a public hospital in Iran on 70 nulliparous women with an episiotomy incision. The women were randomly assigned to ginger extract ointment and placebo groups. The primary outcomes included pain and wound healing that were assessed using a visual analog scale (VAS), redness, edema, ecchymosis/bruising, discharge, and an approximation scale (REEDA). The participants were followed up before discharge from the hospital and 5×1 and 10×1 days after the intervention. The secondary outcome was the number of painkillers used during the study. Data were analyzed by chi-square, independent test, and the Mann-Whitney U via SPSS-13. The significance levels were determined to be ≤0.05.
RESULTS
There was no significant difference between participants treated with ginger extract ointment and placebo in the pain and wound healing scores before the intervention, 5×1 and 10×1 days after the intervention. But, the pain intensity decreased, and the recovery speed increased clinically. Also, regarding the secondary outcome of this study, no significant difference between the placebo and intervention groups in the number of painkillers participants took.
CONCLUSION
The ginger ointment could not significantly improve episiotomy wounds' pain and healing rate, but it was clinically helpful. So more studies with different doses of this ointment are needed.
PubMed: 38020739
DOI: 10.34172/jcs.2023.31842 -
International Journal of Surgery Case... Feb 2024Posterolateral knee dislocations are rare, complex injuries predominantly resulting from high-energy trauma. They present significant diagnostic and therapeutic...
INTRODUCTION AND IMPORTANCE
Posterolateral knee dislocations are rare, complex injuries predominantly resulting from high-energy trauma. They present significant diagnostic and therapeutic challenges, crucial for maintaining long-term knee function and stability.
CASE PRESENTATION
We report the case of Mr. Y.G., a 34-year-old male who suffered a left knee posterolateral dislocation due to a motorcycle accident. Clinical examination and imaging revealed a valgus deformity, swelling, ecchymosis, and a persistent medial joint line groove. The injury was classified based on NEYRET et al. criteria and 2008 SOFCOT standards. Surgical intervention involved repairing medial structures and applying a femoro-tibial external fixator. Radiographic and MRI findings confirmed a complete capsuloligamentous rupture and chondral injury of the lateral condyle.
CLINICAL DISCUSSION
This case exemplifies the critical need for rapid radiological evaluation and tailored surgical interventions in managing posterolateral knee dislocations. It also demonstrates the effectiveness of using established classification systems for treatment planning and prognostic prediction.
CONCLUSION
Timely and suitable management is essential for successfully treating posterolateral knee dislocations. Utilizing recognized classification systems plays a key role in guiding management decisions and improving patient outcomes, ensuring optimal recovery and knee functionality.
PubMed: 38211553
DOI: 10.1016/j.ijscr.2023.109204 -
Plastic and Reconstructive Surgery.... Mar 2024Tranexamic acid (TXA) has demonstrated promising outcomes in plastic surgery. Our aim was to assess the effect of TXA in intraoperative bleeding, operative time, and...
BACKGROUND
Tranexamic acid (TXA) has demonstrated promising outcomes in plastic surgery. Our aim was to assess the effect of TXA in intraoperative bleeding, operative time, and complications among patients undergoing facial surgical procedures.
METHODS
A retrospective cohort study of patients who underwent multiplane facial rhytidectomy from January 2018 to September 2022 at the Clinica Ziegler, Lima, Peru. Patients were divided into two groups according to the use of intravenous plus local infiltration of TXA. We performed the chi square test to assess associations among categorical variables, the Student test and Mann-Whitney U test for categorical with continuous variables, and Pearson correlation for quantitative variables.
RESULTS
A total of 100 patients were included with 50 patients in each group. The median age was 59.5 years and the majority were women (88%). The median operative time was 288.5 minutes. The TXA group presented less intraoperative bleeding (40 versus 90 mL, < 0.05) and shorter operative time (237 versus 353 minutes, < 0.05); no differences in the development of hematoma (2% versus 12%, = 0.11), less ecchymosis (2% versus 36%, < 0.05), edema (2% versus 100%, < 0.05), and time to drain removal (3 versus 6 days, < 0.05).
CONCLUSIONS
TXA improves the short- and long-term outcomes of patients who undergo multiplane facial rhytidectomy. It also decreases intraoperative bleeding by more than half and reduces the operative time by one third. Moreover, patients receiving TXA presented significantly less ecchymosis, edema, and time to drain removal.
PubMed: 38463701
DOI: 10.1097/GOX.0000000000005653 -
Journal of Vascular Surgery. Venous and... Jan 2024Endovenous microwave ablation (EMA) is a recently developed thermal ablation technique used in the treatment of lower limb varicose veins. However, its efficacy and...
OBJECTIVE
Endovenous microwave ablation (EMA) is a recently developed thermal ablation technique used in the treatment of lower limb varicose veins. However, its efficacy and safety have been largely understudied. In the present study, we sought to explore the clinical results of EMA and radiofrequency ablation (RFA) in treating lower limb varicose veins.
METHODS
Patients who underwent EMA (n = 65) or RFA (n = 46) at our institute from September 2018 to September 2020 were included in this retrospective investigation. The clinical results and complications were evaluated at 1, 3, 6, and 12 months after the procedure. The effects on disease severity and quality of life were evaluated using the venous clinical severity score and chronic venous insufficiency questionnaire (CIVIQ).
RESULTS
The technical success rate was 100% for both experimental groups. Although the operative time between the two groups was comparable, the EMA technique was associated with lower direct costs (P < .001), although also with prolonged hospitalization (P < .001). We found that the use of EMA correlated with more pain at 48 hours postoperatively. Except for the visual analog scale scores, no statistically significant variations were observed in the occurrence of postoperative complications within the first 48 hours postoperatively between the EMA and RFA groups, including paresthesia, ecchymosis, induration, and phlebitis (P > .05). At 4 weeks postoperatively, significantly less pigmentation was observed in the RFA group than in the EMA group (13.04% vs 32.31%; P = .020). However, the pigmentation had resolved in all patients by 12 months postoperatively. The two groups had a reduction in the venous clinical severity scores and an increase in the CIVIQ scores after the procedure. However, the CIVIQ scores within the RFA group had increased more than had those within the EMA group (P < .05). No significant differences were found in recurrence between the two groups (EMA group, 1.54%; RFA group, 2.17%; P = .804).
CONCLUSIONS
Both ablation techniques are safe and effective. RFA is associated with relatively higher treatment costs but shorter hospitalization and better quality of life improvement.
Topics: Humans; Varicose Veins; Quality of Life; Retrospective Studies; Microwaves; Venous Insufficiency; Radiofrequency Ablation; Saphenous Vein; Treatment Outcome; Catheter Ablation; Laser Therapy
PubMed: 37572775
DOI: 10.1016/j.jvsv.2023.03.022 -
Frontiers in Pharmacology 2024Wuhu Oral Liquid (WHOL) is a modified preparation derived from the famous Wuhu Powder, which has a long history of use in treating traumatic injuries. This preparation...
Wuhu Oral Liquid (WHOL) is a modified preparation derived from the famous Wuhu Powder, which has a long history of use in treating traumatic injuries. This preparation has anti-inflammatory and analgesic properties and accelerates recovery following acute soft tissue injuries. To evaluate the efficacy and safety of WHOL in treating acute soft tissue injury associated with qi stagnation and blood stasis syndrome and to provide a basis for applying for the protection of varieties of Chinese medicine for WHOL. This study was a randomized, controlled, double-blind, multicenter clinical trial in which Fufang Shang Tong Capsule (FFSTC) was selected as the control drug. A total of 480 subjects with acute soft tissue injury associated with qi stagnation and blood stasis syndrome were randomly divided into a test and control group in a 3:1 ratio. The duration of drug treatment was 10 days. The primary outcome was Visual Analogue Scale (VAS) score for pain (including pain at rest and pain on activity). Secondary outcomes included the disappearance time of the pain at rest and on activity; the curative effect of TCM syndrome and improvement in the individual symptoms of TCM (swelling, ecchymosis, and dysfunction); and changes in C-reactive protein (CRP) and interleukin-6 (IL-6) levels. Safety was assessed using vital signs, laboratory examinations, electrocardiograms, and physical examinations. Patient compliance was satisfactory in both groups (all between 80% and 120%). After 4 days of treatment, the WHOL group was superior to the FFSTC group in decreasing the VAS scores for pain at rest (-1.88 ± 1.13 vs -1.60 ± 0.93, < 0.05) and on activity (-2.16 ± 1.18 vs -1.80 ± 1.07, < 0.05). After 7 days of treatment, the WHOL group was superior to the FFSTC group in decreasing the VAS scores for pain on activity (-3.87 ± 1.60 vs -3.35 ± 1.30, < 0.01) and improving swelling (cure rate: 60.4% vs 46.2%, < 0.05; obvious effective rate: 60.7% vs 47.0%, < 0.05). After 10 days of treatment, the WHOL group was superior to the FFSTC group in decreasing the levels of CRP (-0.13 ± 2.85 vs 0.25 ± 2.09, < 0.05) and improving the TCM syndrome (cure rate: 44.1% vs 30.8%, < 0.05) and swelling (cure rate: 75.6% vs 67.5%, < 0.01; obvious effective rate: 75.6% vs 68.4%, < 0.05; effective rate: 77.0% vs 71.8%, < 0.05). The disappearance time of pain at rest was 8 days in both groups and 9 days on activity in both groups. In addition, there was no statistical difference between the incidence of adverse events (4.5% vs 2.6%, > 0.05) and adverse reactions (0.3% vs 0%, > 0.05) between the WHOL group and the FFSTC group. No serious adverse events occurred in either group, and no subjects were withdrawn because of adverse events. WHOL relieves the symptoms caused by acute soft tissue injury associated with qi stagnation and blood stasis syndrome more rapidly than FFSTC, and it is effective and safe in the treatment of acute soft tissue injury. Future studies still need a larger sample size to verify its efficacy and safety. https:// www.chictr.org.cn/showproj.html?proj=149531, Identifier ChiCTR2200056411.
PubMed: 38464733
DOI: 10.3389/fphar.2024.1335182