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Qatar Medical Journal 2021The central nervous system is an unusual location of sarcoidosis, which commonly affects the cranial nerves, meninges, hypothalamus, and pituitary gland. Involvement of...
BACKGROUND
The central nervous system is an unusual location of sarcoidosis, which commonly affects the cranial nerves, meninges, hypothalamus, and pituitary gland. Involvement of the pineal region is extremely rare. This systematic review focused on the diagnosis and management of pineal region sarcoidosis, dorsal mesencephalon, and periaqueductal region.
OBJECTIVES
This study aimed to discuss diagnostic modalities and best management tools of the aforementioned pathology.
METHODS
ScienceDirect, PubMed, and Google Scholar databases were searched for English or French articles about sarcoidosis of the pineal region, dorsal mesencephalon, and periaqueductal region. The clinical case of a patient managed at our department that we believe is directly relevant to this review is also presented. Patients' demographics, clinical presentations, presence of hydrocephalus, other sarcoidosis locations in the central nervous system, and medical treatment were collected. Surgical management, surgical approach, and outcomes and complications of each procedure were also obtained. This study was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
RESULTS
Fifteen cases were examined. The study sample consisted of nine (60%) male and six (40%) female, and the mean age was 32 years. Eight (53%) patients had hydrocephalus, and the predominant clinical presentations were signs of increasing intracranial pressure (headaches, vomiting, and papilledema). Six (40%) patients had diplopia, and convergence-retraction nystagmus was noted in three (20%) patients. Argyll Robertson sign was present in one patient and suspected in another patient (13%). Medical treatment consisted mainly of steroids (93% of cases). Open surgery on the pineal region was performed in five patients, and four of them reported to have serious complications (such as ophthalmoplegia, hemianopsia, hemiparesis, bilateral third cranial nerve paresis, and cerebellar syndrome). Endoscopic management was performed in two patients without complications.
CONCLUSION
To treat hydrocephalus, brain imaging is mandatory in patients with sarcoidosis if intracranial hypertension is suspected. In pineal region sarcoidosis, management of hydrocephalus is the priority, followed by medical treatment of the lesion. Open surgery of any approach presents a high risk of complications; thus, an endoscopic approach is the preferred management, as it treats hydrocephalus and makes biopsy possible with minimal risk.
PubMed: 34466394
DOI: 10.5339/qmj.2021.29 -
Journal of Biomechanics Apr 2021Lisfranc injuries are challenging to treat and can have a detrimental effect on active individuals. Over the past decade researchers have investigated methods for the... (Review)
Review
Lisfranc injuries are challenging to treat and can have a detrimental effect on active individuals. Over the past decade researchers have investigated methods for the reconstruction of the Lisfranc ligamentous complex (LLC) to preserve its functional stability and mobility. To aid in this innovation, this study presents the current understanding of the anatomical and biomechanical characteristics of the LLC through a systematic review. Three medical databases (PubMed, Scopus, and Embase) were searched from inception through July 2019. Original studies investigating the anatomy and/or biomechanical properties of the LLC were considered for inclusion. Data recorded from each study included: number of cadavers, number of feet, gender, laterality, age, type of specimen, measurement methods, reported ligamentous bundles, ligament origins and insertions, geometric characteristics, and biomechanical properties of the LLC. The Quality Appraisal for Cadaveric Studies (QUACS) scale was used to assess the methodologic quality of included articles. Eight cadaveric studies investigating the LLC were included out of 1204 screened articles. Most articles described the LLC as three distinct structures: the dorsal- (DLL), interosseous- (ILL), and plantar- (PLL) Lisfranc Ligaments. The ILL had the largest thickness and insertional area of osseous attachment. Biomechanically, the ILL also had the highest stiffness and resistance to load prior to failure when loaded parallel to its fiber orientation. Current knowledge of the anatomical and biomechanical properties of the LLC are presented and highlight its significant role of stabilizing the tarsometatarsal articulation. Appreciating the biomechanical characteristics of the ILL may improve clinical insight in managing LLC injuries.
Topics: Biomechanical Phenomena; Biophysics; Cadaver; Foot Joints; Humans; Ligaments, Articular
PubMed: 33639336
DOI: 10.1016/j.jbiomech.2021.110287 -
European Journal of Oral Implantology 2016This study evaluated the efficacy of replacing single missing teeth in the posterior quadrants of the maxilla and/or mandible with an implant-supported dental prosthesis. (Review)
Review
AIM
This study evaluated the efficacy of replacing single missing teeth in the posterior quadrants of the maxilla and/or mandible with an implant-supported dental prosthesis.
MATERIAL AND METHODS
Three scientific literature databases - Medline (Pubmed), Ovid Medline and Cochrane Central Register of Controlled Trials (CENTRAL) - were used to perform a search of publications over a period from 1985 to 2014. One hundred and forty one (141) articles were reviewed; 36 articles met the inclusion criteria and were included in the final review.
RESULTS
The survival rates, success rates and mean bone loss for immediate implant placement were 96.9%, 100% and 0.85 mm, respectively. The survival rates, success rates and mean bone loss for delayed implant placement were 96.8%, 94.1% and 0.55 mm respectively. The survival rate, success rate and the mean bone loss in studies comparing immediate versus delayed implant placement showed 96.8% and 96.3%, 85.8% and 93.3%, and 0.57 ± 0.57 mm and 0.55 ± 0.37 mm, respectively.
CONCLUSION
The prognosis for single molar implants provides a viable treatment option for replacing a single missing tooth in the posterior quadrants of the maxilla and mandible. There does not appear to be a significant difference in the survival rates of immediately placed implants compared with delayed implant placement. However, the success rates were slightly higher with delayed loading protocols than immediate loading protocols.
Topics: Alveolar Bone Loss; Dental Arch; Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Dental Prosthesis, Implant-Supported; Humans; Immediate Dental Implant Loading; Survival Analysis; Tooth Loss; Treatment Outcome
PubMed: 27314123
DOI: No ID Found -
The Journal of Hand Surgery Jul 2021This study presents patient demographics, injury characteristics, outcomes, and complications associated with dorsal bridge plating (DBP) in the treatment of distal...
PURPOSE
This study presents patient demographics, injury characteristics, outcomes, and complications associated with dorsal bridge plating (DBP) in the treatment of distal radius fractures.
METHODS
A literature search performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines identified 206 articles, 12 of which met inclusion criteria, accounting for 310 patients. Included articles contained the results of DBP for treatment of distal radius fractures with reported outcomes between 1988 and 2018. Data were pooled and analyzed focusing on patient demographics, as well as 3 primary outcomes of complications, range of motion (ROM), and Disabilities of the Arm, Shoulder, and Hand (DASH) and QuickDASH scores.
RESULTS
Average age was 55 years, median follow-up was 24 months, and the most common use was in comminuted (92%) intra-articular (92%) distal radius fracture caused by fall (58%), or motor vehicle collision or motorcycle collision (27%). A minority of patients had open fractures (16%) and most were cases of polytrauma (65%). Median time from placement to DBP removal was 17 weeks (mean, 119 days). At final follow-up, mean wrist ROM was 45° flexion, 50° extension, 75° pronation, and 73° supination. Mean DASH score was 26.1, and mean QuickDASH score was 19.8. The overall rate for any complication was 13%; the most common was hardware failure (3%) followed by symptomatic malunion or nonunion (3%), and persistent pain after hardware removal (2%).
CONCLUSIONS
Dorsal bridge plating was found to be used most commonly in intra-articular, comminuted distal radius fractures with overall functional wrist ROM, moderate patient-reported disability, and a 13% complication rate at follow-up.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Bone Plates; Fracture Fixation, Internal; Fractures, Comminuted; Humans; Middle Aged; Radius Fractures; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Wrist Joint
PubMed: 33573844
DOI: 10.1016/j.jhsa.2020.11.026 -
Neural Regeneration Research Nov 2023Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention. Previous clinical and neuroimaging...
Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention. Previous clinical and neuroimaging studies have suggested that the neural mechanisms underlying strabismic amblyopia and anisometropic amblyopia may be different. Therefore, we performed a systematic review of magnetic resonance imaging studies investigating brain alterations in patients with these two subtypes of amblyopia; this study is registered with PROSPERO (registration ID: CRD42022349191). We searched three online databases (PubMed, EMBASE, and Web of Science) from inception to April 1, 2022; 39 studies with 633 patients (324 patients with anisometropic amblyopia and 309 patients with strabismic amblyopia) and 580 healthy controls met the inclusion criteria (e.g., case-control designed, peer-reviewed articles) and were included in this review. These studies highlighted that both strabismic amblyopia and anisometropic amblyopia patients showed reduced activation and distorted topological cortical activated maps in the striate and extrastriate cortices during task-based functional magnetic resonance imaging with spatial-frequency stimulus and retinotopic representations, respectively; these may have arisen from abnormal visual experiences. Compensations for amblyopia that are reflected in enhanced spontaneous brain function have been reported in the early visual cortices in the resting state, as well as reduced functional connectivity in the dorsal pathway and structural connections in the ventral pathway in both anisometropic amblyopia and strabismic amblyopia patients. The shared dysfunction of anisometropic amblyopia and strabismic amblyopia patients, relative to controls, is also characterized by reduced spontaneous brain activity in the oculomotor cortex, mainly involving the frontal and parietal eye fields and the cerebellum; this may underlie the neural mechanisms of fixation instability and anomalous saccades in amblyopia. With regards to specific alterations of the two forms of amblyopia, anisometropic amblyopia patients suffer more microstructural impairments in the precortical pathway than strabismic amblyopia patients, as reflected by diffusion tensor imaging, and more significant dysfunction and structural loss in the ventral pathway. Strabismic amblyopia patients experience more attenuation of activation in the extrastriate cortex than in the striate cortex when compared to anisometropic amblyopia patients. Finally, brain structural magnetic resonance imaging alterations tend to be lateralized in the adult anisometropic amblyopia patients, and the patterns of brain alterations are more limited in amblyopic adults than in children. In conclusion, magnetic resonance imaging studies provide important insights into the brain alterations underlying the pathophysiology of amblyopia and demonstrate common and specific alterations in anisometropic amblyopia and strabismic amblyopia patients; these alterations may improve our understanding of the neural mechanisms underlying amblyopia.
PubMed: 37282452
DOI: 10.4103/1673-5374.371349 -
Pain and Therapy Jun 2022Systematic literature review. (Review)
Review
STUDY DESIGN
Systematic literature review.
OBJECTIVE
The goal of this systematic review is to assess the clinical safety and potential complications of conventional and pulsed radiofrequency ablations targeting dorsal root entry zone complex (DREZC) components in the treatment of chronic pain.
BACKGROUND
There is a growing popularity for the use of radiofrequency ablation (RFA) techniques targeting DREZC components by pain management physicians for an increasing variety of indications. To date, we lack a systematic review to describe the safety and the type of complications associated with these procedures.
METHODS
This was a systematic literature review. This systematic search was limited to peer-reviewed literature using "radiofrequency ablation" as a search keyword using PubMed's database for manuscripts published between inception and December 2020. Abstracts that involved the application of radiofrequency currents, of any modality, to DREZC components for the treatment of pain were included for full-text review. Search was limited to original data describing clinical outcomes following RFA performed for pain indications only, involving the DREZC components outlined above, in human subjects, and written in English. The primary outcomes were complications associated with conventional RFA and pulsed radiofrequency ablation (PRF). Complications were categorized as type 1 (persistent neurological deficits or other serious adverse events, defined as any event that resulted in permanent of prolonged injury; type 2 (transient neuritis or neurological deficits, or other non-neurological non-minor adverse event); type 3 (minor adverse events (e.g., headache, soreness, bruising, etc.).
RESULTS
Of the 62 selected manuscripts totaling 3157 patients, there were zero serious adverse events or persistent neurological deficits reported. A total of 36 (1.14%) transient neurological deficits, cases of transient neuritis, or non-minor adverse events like uncomplicated pneumothorax were reported. A total of 113 (3.58%) minor adverse events were reported (bruising, transient site soreness, headache).
CONCLUSIONS
This systematic review indicates that the use of RFA lesion of the DREZC for interventional pain management is very safe. There were no serious adverse effects with a sizable sample of randomized controlled trial (RCT), prospective observational, and retrospective studies.
PubMed: 35434768
DOI: 10.1007/s40122-022-00378-w -
Journal of Pediatric Urology Apr 2020Excellent outcomes have been reported following the widely accepted tubularized incised plate urethroplasty (TIPU) and its relatively recent modification, the dorsal... (Meta-Analysis)
Meta-Analysis Review
Comparing the outcomes of tubularized incised plate urethroplasty and dorsal inlay graft urethroplasty in children with hypospadias: a systematic review and meta-analysis.
BACKGROUND
Excellent outcomes have been reported following the widely accepted tubularized incised plate urethroplasty (TIPU) and its relatively recent modification, the dorsal inlay graft urethroplasty (DIGU). However, there is a lack of consensus on which technique offers more favorable postoperative outcomes.
AIMS
To systematically compare the reported outcomes of the TIPU and DIGU techniques in children undergoing primary hypospadias repair.
DESIGN
A systematic review and meta-analysis of randomized and observational studies.
METHODS
An electronic database search was conducted up to May 2018. Sources included Medline, Embase, Cochrane library, CINAHL, Web of Science, and Google Scholar as well as trial registries and grey literature sources. Studies were selected if they compared the postoperative complications of TIPU and DIGU in children. Secondary outcomes included standardized cosmetic scores and urinary flow studies. A meta-analysis of reported complications was performed using a random-effects model.
RESULTS
Two randomized, two prospective, and two retrospective studies met the inclusion criteria. TIPU and DIGU were performed in 350 and 267 patients, respectively. Pooled analysis did not demonstrate a significant difference regarding postoperative urethrocutaneous fistula, meatal/urethral stenosis, wound dehiscence, or total complications. Subgroup analysis according to hypospadias severity did not alter initial findings. Statistical analysis of secondary outcomes was not feasible due to insufficient data. Most studies were of low methodological quality with a high risk of bias.
CONCLUSIONS
There is no strong evidence to suggest that either technique offers more favorable outcomes. Until more robust randomized trials exist, decisions regarding the appropriate repair should be based on the surgeon's experience and outcomes.
Topics: Child; Humans; Hypospadias; Infant; Male; Prospective Studies; Retrospective Studies; Surgical Flaps; Treatment Outcome; Urethra; Urologic Surgical Procedures, Male
PubMed: 32061491
DOI: 10.1016/j.jpurol.2020.01.009 -
Journal of Plastic Surgery and Hand... 2023Local anesthesia is an effective method to perform digital nerve blocks. In this study, we compare the effectiveness of single-volar subcutaneous and double-dorsal... (Meta-Analysis)
Meta-Analysis
Comparison of the effectiveness of local anesthesia for the digital block between single-volar subcutaneous and double-dorsal finger injections: a systematic review and meta-analysis of randomized control trials.
Local anesthesia is an effective method to perform digital nerve blocks. In this study, we compare the effectiveness of single-volar subcutaneous and double-dorsal injection through a systematic review and meta-analysis of randomized controlled trials (RCTs). A systematic search of PubMed, Embase, and the Cochrane Library from inception to 7 April 2021 was performed. RCTs with the effects of single-volar subcutaneous and double-dorsal injection were eligible. Meta-analysis was performed using random effect models with pooled standardized mean differences (SMDs) and 95% confidence intervals (CI). RoB 2.0 and GRADE of Recommendation Assessment, Development, and Evaluation criteria were applied for evaluating the bias. A total of 2484 studies were initially identified, with 11 eligible RCTs finally included in the meta-analysis (1363 patients). The pooled data of nine studies showed single-volar injection had a statistically significantly lower pain score (pooled SMD: 0.20, 95% CI, 0.01 to 0.39, = 0.041, I2 = 58%, = 1187) and higher patient preference but invalid anesthesia at the dorsal proximal digit. No significant differences were observed in the onset of anesthesia, adjacent digit invalid numbness, distal phalanx invalid anesthesia, additional injection rate, and adverse effects. In conclusion, this meta-analysis of RCTs showed that the single-volar injection was associated with a lower pain sensation during injection and higher patient satisfaction with a reduced anesthetic effect over the proximal dorsal phalanx. Further high-quality RCTs with a higher number of cases are needed to validate our results.
Topics: Humans; Anesthesia, Local; Anesthetics, Local; Injections, Subcutaneous; Fingers; Pain
PubMed: 35522838
DOI: 10.1080/2000656X.2022.2070177 -
Annals of Plastic Surgery Oct 2022The flaps in the trapezius region are routinely elevated as musculocutaneous flaps. The anatomy of trapezius perforators and their clinical application are unclear.
BACKGROUND
The flaps in the trapezius region are routinely elevated as musculocutaneous flaps. The anatomy of trapezius perforators and their clinical application are unclear.
METHODS
The number and distribution of superficial cervical artery perforators (SCAPs) and dorsal scapular artery perforators (DSAPs) were studied on 8 cadavers. The clinical usage of SCAP and DSAP flaps was investigated through a systematic literature review.
RESULTS
A total of 27 SCAPs and 28 DSAPs were found in the 16 hemibacks. The mean calibers of SCAP and DSAP were 0.9 ± 0.2 and 0.8 ± 0.2 mm, respectively. The vascular length to the takeoff of the source artery was 7.3 ± 2.0 cm (range, 4.7-9.7 cm) for SCAPs and was 8.1 ± 2.8 cm (range, 3.2-13.6 cm) for DSAPs. Contour and density heat maps showed that the SCAPs were clustered within approximately 3 to 5 cm above the horizontal line through the medial point of the scapular spine (x-axis) and 5 to 8 cm from the midline (y-axis, P = 0.001) and clustered DSAPs located in approximately 4 to 9 cm below the x-axis and 4 to 10 cm from the y-axis ( P = 0.002). Four SCAP and 19 DSAP flaps were found in literature. The mean sizes of SCAP flaps and DSAP flaps were 18.5 × 7.8 and 16.5 × 8.7 cm, respectively.
CONCLUSIONS
Both SCAP and DSAP flaps can be elevated with a relatively long pedicle. The anatomical knowledge of the location of major clusters of perforators contributes to the application of these flaps.
Topics: Arteries; Cadaver; Humans; Neck; Perforator Flap; Superficial Back Muscles
PubMed: 35502939
DOI: 10.1097/SAP.0000000000003192 -
Plastic and Reconstructive Surgery May 2017Outcomes after implant arthroplasty for primary degenerative and posttraumatic osteoarthritis of the proximal interphalangeal joint were different according to the... (Comparative Study)
Comparative Study Review
BACKGROUND
Outcomes after implant arthroplasty for primary degenerative and posttraumatic osteoarthritis of the proximal interphalangeal joint were different according to the implant design and surgical approach. The purpose of this systematic review was to evaluate outcomes of various types of implant arthroplasty for proximal interphalangeal joint osteoarthritis, with an emphasis on different surgical approaches.
METHODS
The authors searched all available literature in the PubMed and EMBASE databases for articles reporting on outcomes of implant arthroplasty for proximal interphalangeal joint osteoarthritis. Data collection included active arc of motion, extension lag, and complications. The authors combined the data of various types of surface replacement arthroplasty into one group for comparison with silicone arthroplasty.
RESULTS
A total of 849 articles were screened, yielding 40 studies for final review. The mean postoperative arc of motion and the mean gain in arc of motion of silicone implant with the volar approach were 58 and 17 degrees, respectively, which was greater than surface replacement implant with the dorsal approach at 51 and 8 degrees, respectively. The mean postoperative extension lag of silicone implant with the volar approach and surface replacement with the dorsal approach was 5 and 14 degrees, respectively. The revision rate of silicone implant with the volar approach and surface replacement with the dorsal approach was 6 percent and 18 percent at a mean follow-up of 41.2 and 51 months, respectively.
CONCLUSION
Silicone implant with the volar approach showed the best arc of motion, with less extension lag and fewer complications after surgery among all the implant designs and surgical approaches.
Topics: Adolescent; Arthroplasty; Finger Joint; Humans; Joint Prosthesis; Osteoarthritis; Postoperative Complications; Prosthesis Design; Treatment Outcome
PubMed: 28445369
DOI: 10.1097/PRS.0000000000003260