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Cureus Mar 2024Introduction Cell phone usage has tremendously increased, and to make usage comfortable, accessories such as Bluetooth earphones are available. But still, most people...
Introduction Cell phone usage has tremendously increased, and to make usage comfortable, accessories such as Bluetooth earphones are available. But still, most people use cell phones for a long period of time by flexing their elbows near their ears. When the users flex the elbow to hold the phone near the ear, this results in increased pressure over the ulnar nerve since the ulnar nerve runs superficially at the level of the elbow. The extensive pressure over the ulnar nerve may result in nerve compression, which results in cubital tunnel syndrome, recently called the cell phone elbow. Hence, this study was undertaken to assess the ulnar nerve function among cell phone users in relation to the duration of usage. Materials and methods Young healthy volunteers (n = 30) aged between 20 and 25 years were selected for the study in order to prevent age-related neuropathic changes. After getting a history of mobile phone usage, the subjects were asked about neural symptoms such as tingling, numbness, and pain while using cell phones. Ulnar nerve function was assessed by Froment's sign and Wartenberg's sign. An ulnar nerve conduction study was done. Results Seventy percent of the subjects (n = 21) out of the 30 subjects participating in the study reported tingling and numbness during mobile phone usage. But Froment's sign and Wartenberg's sign were negative for all the subjects. There was a significant positive correlation (r = 0.913 and r = 0.8253) between the duration of mobile phone use and latency and a negative correlation (r = -0.8439) with conduction velocity. Conclusion The malposition of the elbow during prolonged cell phone use results in ulnar nerve entrapment. The continuous usage of cell phones without rest by flexing the elbow causes nerve compression. This can be taken as a warning sign to prevent further damage.
PubMed: 38571821
DOI: 10.7759/cureus.55500 -
Interdisciplinary Cardiovascular and... Mar 2024To study the risk factors for mortality, moderate or more left atrioventricular valve regurgitation (LAVVR) and reoperation after the surgical repair of complete...
OBJECTIVES
To study the risk factors for mortality, moderate or more left atrioventricular valve regurgitation (LAVVR) and reoperation after the surgical repair of complete atrioventricular septal defect (cAVSD) in a single centre.
METHODS
The current study is a retrospective review of patients who underwent surgical repair of cAVSD between 2000 and 2021. Patients with unbalanced ventricles not amenable to biventricular repair, double outlet right ventricle and malpositioned great arteries were excluded. The clinical predictors of outcome for end points were analysed with univariate and multivariable Cox regression analysis or Fine-Gray modelling for competing risks. Time-dependent end points were estimated using the Kaplan-Meier curve analysis and cumulative incidence curves.
RESULTS
The median follow-up time was 2.3 years. Among 220 consecutive patients were 10 (4.6%) operative and 21 late mortalities (9.6%). A total of 26 patients were identified to have immediate postoperative moderate or more regurgitation and 10 of them ultimately died. By multivariable analysis prematurity and having more than moderate regurgitation immediately after the operation were identified as predictors of overall mortality (P = 0.003, P = 0.012). Five- and ten-year survival rates were lower for patients with immediate postoperative moderate or more LAVVR {51.9% [confidence interval (CI): 27.5-71.7%]} when compared to patients without moderate or more regurgitation [93.2% (CI: 87.1-96.4%) and 91.3% (CI: 83.6-95.5%)].
CONCLUSIONS
The patients who undergo cAVSD repair remain subjected to a heavy burden of disease related to postoperative residual LAVVR. Immediate postoperative moderate or more LAVVR contributes significantly to overall mortality. Whether a second run of bypass can decrease this observed mortality should be investigated.
PubMed: 38569897
DOI: 10.1093/icvts/ivae053 -
Bone & Joint Open Apr 2024Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and...
AIMS
Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions.
METHODS
A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed.
RESULTS
CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance.
CONCLUSION
This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival.
PubMed: 38555947
DOI: 10.1302/2633-1462.54.BJO-2023-0185.R1 -
Medicine Mar 2024Situs inversus totalis is a rare malposition of organs that typically involves lesions in the respiratory, circulatory, or urinary systems. Cases of congenital...
RATIONALE
Situs inversus totalis is a rare malposition of organs that typically involves lesions in the respiratory, circulatory, or urinary systems. Cases of congenital hemivertebrae combined with situs inversus totalis are extremely rare and have limited reports.
PATIENT CONCERNS
We report a 2.5 years old girl with 2 congenital hemipyramids and complete visceral inversion who ultimately underwent hemilaminectomy.
DIAGNOSIS
Congenital hemivertebrae combined with situs inversus totalis.
INTERVENTION
The patient underwent hemilaminectomy.
OUTCOMES
The spinal deformity was corrected.
LESSONS
For patient with spinal deformities combined with situs inversus totalis, surgery can be an effective treatment method. But we also need to be vigilant about the dysfunction of various systems.
Topics: Female; Humans; Child, Preschool; Dextrocardia; Situs Inversus; Musculoskeletal Abnormalities; Laminectomy; Treatment Outcome
PubMed: 38552073
DOI: 10.1097/MD.0000000000037625 -
Journal of Clinical Medicine Mar 2024: Central venous catheters (CVCs) are indispensable tools in intensive care and emergency medicine. CVC malpositions still occur frequently and can cause various...
: Central venous catheters (CVCs) are indispensable tools in intensive care and emergency medicine. CVC malpositions still occur frequently and can cause various complications leading to increased patient mortality. A microbubbles test (MBT) can be used to confirm correct CVC positioning. However, there is serious doubt regarding whether the currently applied threshold of a 2 s push-to-bubbles time (PTB time) for rapid atrial swirl sign (RASS) in an MBT is reliable and accurate. The aim of the present study was to prove the quality of a new threshold: 1 s. : Consecutive patients who were admitted to the intensive care unit (ICU) in a German neurological specialist hospital from 1 March 2021 to 20 July 2022 were enrolled. After ultrasound-guided CVC insertion, an MBT was performed, PTB time was measured, and RASS was interpreted. Additionally, a chest X-ray (CXR) was requested to check CVC position. : A total of 102 CVCs (98% jugular and 2% subclavian) were inserted in 102 patients (38% female and 62% male; median age: 66 years). Negative RASS (PTB time > 1 s) was observed in 2 out of 102 patients, resulting in an echocardiographic malposition rate of 2.0%. CXR confirmed the echocardiographic results. After correcting CVC position in the initially malpositioned CVCs, the PTB time was <1 s (positive RASS). The MBT protocol took about 0.5 min on average, while the CXR results were all available within 30 min. Sensitivity, specificity, and positive and negative predictive value were each 100% for the detection of CVC malpositions via an MBT using a threshold of 1 s compared to CXR. : A new threshold of a 1 s PTB time for RASS in an MBT could detect CVC malpositions with excellent quality compared to CXR. Since the MBT was fast and safe and could be performed at the bedside, we propose that an MBT with the new and reliable threshold of 1 s should be routinely used in patient care.
PubMed: 38541883
DOI: 10.3390/jcm13061657 -
Emergency Radiology Jun 2024Artificial Intelligence (AI) has emerged as a transformative force within medical imaging, making significant strides within emergency radiology. Presently, there is a... (Review)
Review
Artificial Intelligence (AI) has emerged as a transformative force within medical imaging, making significant strides within emergency radiology. Presently, there is a strong reliance on radiologists to accurately diagnose and characterize foreign bodies in a timely fashion, a task that can be readily augmented with AI tools. This article will first explore the most common clinical scenarios involving foreign bodies, such as retained surgical instruments, open and penetrating injuries, catheter and tube malposition, and foreign body ingestion and aspiration. By initially exploring the existing imaging techniques employed for diagnosing these conditions, the potential role of AI in detecting non-biological materials can be better elucidated. Yet, the heterogeneous nature of foreign bodies and limited data availability complicates the development of computer-aided detection models. Despite these challenges, integrating AI can potentially decrease radiologist workload, enhance diagnostic accuracy, and improve patient outcomes.
Topics: Humans; Artificial Intelligence; Foreign Bodies
PubMed: 38530436
DOI: 10.1007/s10140-024-02222-4 -
Acta Orthopaedica Et Traumatologica... Jan 2024The aim of this study was to evaluate the posterior condylar angle (PCA) and condylar twist angle (CTA) of the distal femur in the Turkish population and its concordance...
OBJECTIVE
The aim of this study was to evaluate the posterior condylar angle (PCA) and condylar twist angle (CTA) of the distal femur in the Turkish population and its concordance with the current standard prosthesis guides used in total knee arthroplasty (TKA).
METHODS
Two hundred and forty knees of 120 Turkish subjects (60 male and 60 female) were included in this study. PCA, CTA, femoral mediolateral lengths (fML), medial femoral anteroposterior lengths (fMAP), lateral femoral anteroposterior lengths (fLAP), distances between the trochlear groove and fMAP (DBTG-fMAP), distances between the trochlear groove and fLAP (DBTG-fLAP), medial posterior condylar cartilage thickness (MPCCT) and lateral posterior condylar cartilage thicknesses (LPCCT) were measured on magnetic resonance imaging (MRI).
RESULTS
The median CTA was 7° (range: 0°-13.0°) and the median PCA was 4° (range 0°-11.0°) (P < .0001). The median fML was 79.5 mm (range: 65.7-98.9). The median length of the fMAP was 58.2 mm (range: 46.8-69.0) and the median length of fLAP was 58.2 mm (range: 48.4-73.0). The DBTG-fMAP was 15.2 mm (range: 5.2-23.2), and DBTG-fLAP length was 21.9mm (range: 16.4-29.4). The median MPCCT and LPCCT were 2.4 mm (range: 1.6-3.6) and 2.3 mm (range: 1.2-2.8), respectively. The intraclass correlation coefficient for quantifying interobserver and intraobserver reliability showed excellent agreement regarding the PCA and CTA.
CONCLUSION
This study has shown us that PCA and CTA may be higher in the Turkish population. Although it is not known whether these results have any clinical utility, it may be useful for surgeons to keep this in mind to prevent femoral component malposition.
LEVEL OF EVIDENCE
Level IV, Diagnostic Study.
Topics: Humans; Male; Female; Arthroplasty, Replacement, Knee; Knee Joint; Reproducibility of Results; Fluorometholone; Femur; Osteoarthritis, Knee
PubMed: 38525509
DOI: 10.5152/j.aott.2024.21066 -
Alternative Therapies in Health and... Mar 2024The efficacy of selective malposition ligation combined with hemorrhoid and fistula I prescription and the improvement of complications were assessed to improve surgical...
OBJECTIVE
The efficacy of selective malposition ligation combined with hemorrhoid and fistula I prescription and the improvement of complications were assessed to improve surgical efficiency and safety.
METHODS
423 patients undergoing complex mixed hemorrhoid surgery at different time points were included as research objects and enrolled into group A (malposition ligation), group B (selective malposition ligation), and group C (selective malposition ligation and hemorrhoid and fistula I), each with 141 cases.
RESULTS
The scores for visual analogue scale (VAS), edema, and hemorrhage of group C 8h, 1 day, 2 days, 3 days, 5 days, and 7 days after surgery were all inferior to those in groups A and B, while that of group B was inferior to that in group A (P < .05). The duration of wound healing of group C (15.33 ± 2.78 days) was shorter than that of groups A (21.78 ± 3.22 days) and B (18.34 ± 3.01 days), and this duration of group B was shorter than that of group A (P < .05). The total effective rate of group C (96.45%) was superior to that of groups B (96.45%) and A (82.27%). The total effective rate of group B was superior to that of group A. The falling-off rate of the rubber ring in groups C and B was inferior to that in group A. The incidence of total complications in group C (9.93%) was inferior to that in groups B (30.50%) and A (30.50%), while that of group B was inferior to that in group A (P < .05).
CONCLUSION
After selective malposition ligation, the oral intake of hemorrhoid and fistula I could promote the recovery of wounds among patients with complex mixed hemorrhoids and reduce the incidence of postoperative hemorrhage and edema. Hence, it has significant clinical application values.
PubMed: 38518140
DOI: No ID Found -
Cureus Feb 2024This study examines a complex scenario of structural valve degeneration (SVD) in a high surgical-risk patient with a previously implanted 25 mm Carpentier-Edwards (CE)...
This study examines a complex scenario of structural valve degeneration (SVD) in a high surgical-risk patient with a previously implanted 25 mm Carpentier-Edwards (CE) Perimount Magna Ease 3300 (Irvine, CA: Edwards Lifesciences) surgical bioprosthetic valve (SAV), the patient presented with both paravalvular leak (PVL) and central prosthetic valve insufficiency (PVI). The patient was considered for a transaortic valve-in-valve (ViV) intervention with a self-expanding 29 mm Evolut R valve (Minneapolis, MN: Medtronic). The case describes a ViV intervention complicated by the malpositioning of the Evolut R valve secondary to micro-dislodgement into the left ventricular outflow tract (LVOT) after deployment and subsequent migration into the LVOT during an attempted bioprosthetic valve fracture (BVF) of the SAV that aimed to decrease transvalvular gradients. The resulting acute severe PVL resulted in significant hemodynamic deterioration, necessitating emergent intervention by implanting a balloon-expandable 26 mm Edwards SAPIEN 3 valve (Irvine, CA: Edwards Lifesciences), effectively averting the need for a surgical valve explant. This study illuminates the intricacies and emergency management strategies in transcatheter aortic valve replacement (TAVR) procedures, particularly in high-risk patients with SVD, and offers critical insights into the challenges and solutions in ViV implantations.
PubMed: 38496184
DOI: 10.7759/cureus.54318 -
Australian Critical Care : Official... Mar 2024Umbilical catheters are commonly inserted in newborns in the neonatal intensive care unit (NICU) yet are associated with serious adverse events (AEs) such as...
BACKGROUND
Umbilical catheters are commonly inserted in newborns in the neonatal intensive care unit (NICU) yet are associated with serious adverse events (AEs) such as malposition, migration, infection, thrombosis, hepatic complications, cardiac effusion, and cardiac tamponade. There is a need to determine the incidence and risk factors for AEs to inform safe practice.
OBJECTIVES
The objective of this study was to determine the incidence and risk factors for AEs (all-cause and individual types) associated with umbilical venous catheters (UVCs) and umbilical arterial catheters (UACs) in the NICU.
METHODS
A retrospective cohort study was conducted in an Australian level-VI NICU over a 3-year period. Any newborn who had both a UVC and UAC insertion attempt was included.
RESULTS
There were 236 neonates who had 494 catheters (245 UVCs and 249 UACs). Of these, 71% of UVCs (95% confidence interval [CI]: 65.6-76.9%; incidence rate: 181.1-237.3 per 1000 catheter days) and 43.8% of UACs (95% CI: 38-50.5%; incidence rate: 102.0-146.3 per 1000 catheter days) were associated with an AE. The most common AE was malposition on first X-ray for UVCs (60.1%, 95% CI: 55.1-67.3) and UACs (32.6%, 95% CI: 26.8-39.6). A dwell time of ≥7 days was a significant predictor of UAC failure (incidence risk ratio: 1.5, 95% CI: 1.1-2.1, p = 0.006) and migration of the UVC (incidence risk ratio: 3.5, 95% CI: 1.0-11.5, p = 0.043).
CONCLUSION
Adverse events related to insertion occurred in a relatively high percentage of umbilical catheters placed. Increased dwell time remains a significant risk factor for catheter migration and overall failure. Practice change and consideration of risk factors for both individual and overall AE risk are necessary to reduce complications.
PubMed: 38485556
DOI: 10.1016/j.aucc.2024.01.013