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Severe complex neglected infantile Blount disease acute correction by Ilizarov frame: A case report.International Journal of Surgery Case... Jun 2024Blount disease is a disorder causing three proportions of deformity, including varus deformity, procurvatum deformity, and internal tibial rotational deformity. The...
INTRODUCTION
Blount disease is a disorder causing three proportions of deformity, including varus deformity, procurvatum deformity, and internal tibial rotational deformity. The standardized treatment remains controversial despite extensive reviews. The application of Ilizarov external fixators for circumspect corrections is established. The SCARE 2023 criteria have been followed in reporting the case report.
CASE PRESENTATION
We present the case of a nine-year-old girl who's complaining about bowing on both of her knees. From the examination, we found that the metaphyseodiaphyseal angle of both knees was 50 degrees. On the right knee, there is 125 degrees of procurvatum deformity and 115 degrees of deformity on the left knee. After performing deformity correction with the Ilizarov application, there's clinical improvement in the patient.
CLINICAL DISCUSSION
Some experts advise using physeal distraction to manage the deformity in order to achieve correction. The limited popularity of physeal distraction technique may be attributed to the risks of premature closure of the growth plate that we manage to avoid. The Ilizarov frame provides maximum adjustability for aligning all planes, making it suitable for treating severe deformities. Secure fixation, improved patient mobility, being able to assess patient alignment in a functional standing position, and precision.
CONCLUSION
Acute correction and fixation using circular frames as a treatment option for Blount disease show positive outcomes without any significant complications.
PubMed: 38917699
DOI: 10.1016/j.ijscr.2024.109909 -
The Journal of Arthroplasty Jun 2024Recent liquid adhesive skin closure systems with a mesh patch and a 2-octyl cyanoacrylate liquid formula have shown promising results in total joint arthroplasty (TJA)....
INTRODUCTION
Recent liquid adhesive skin closure systems with a mesh patch and a 2-octyl cyanoacrylate liquid formula have shown promising results in total joint arthroplasty (TJA). Chemical accelerators are typically included to promote the rapid polymerization of 2-octyl cyanoacrylate. The goal of the study is to distinguish designs and wound complication differences between two similar systems.
METHODOLOGY
An eighteen-week retrospective study was conducted from July to December 2023, including 207 total hip arthroplasty (THA) and 212 total knee arthroplasty (TKA) cases from four attending surgeons at one institution that used one of two dressing designs. Both dressings had a 2-octyl cyanoacrylate liquid adhesive formula that applied topically to a polyester-based mesh overlaying the wound. Mesh A (used in 274 cases) included an accelerator, a quaternary ammonium salt, on the mesh patch, whereas Mesh B (used in 145 cases) included a similar accelerator within the adhesive applicator.
RESULTS
Wound complications (3.2 versus 7.6%; X = 3.86; df = 1; P = 0.049), early periprosthetic joint infections (PJI) (0 versus 2.8%; X = 7.63; df = 1; P = 0.006), and 90-day reoperations for wound complications (0.4 versus 3.4%; X = 6.39; df = 1; P = 0.011) were significantly lower in patients who received Mesh A versus B, respectively. There was no difference in superficial surgical site infections (SSI) (0.7 versus 0%; X = 1.06; df = 1; P = 0.302) or allergy rates (3.3 versus 4.1%; X = 0.12; df = 1; P = 0.655) between Mesh A and B.
CONCLUSION
We observed significantly different performance in wound complications, early postoperative PJI, and 90-day reoperation between the two designs. Having the accelerator in the applicator rather than on the mesh patch, may lead to premature polymerization before bonding appropriately with the mesh to create the desired wound closure and seal.
PubMed: 38914145
DOI: 10.1016/j.arth.2024.06.049 -
Endoscopy International Open Jun 2024Endoscopic through-the-scope clips (TTSC) are used for hemostasis and closure. We documented the performance of a new TTSC with anchor prongs. We conducted a...
Endoscopic through-the-scope clips (TTSC) are used for hemostasis and closure. We documented the performance of a new TTSC with anchor prongs. We conducted a prospective case series of the new TTSC in 50 patients with an indication for endoscopic clipping at three hospitals in the United States and Canada. Patients were followed for 30 days after the index procedure. Outcomes included defect closure and rate of serious adverse events (SAEs) related to the device or procedure. Fifty patients had 56 clipping procedures. Thirty-four procedures were clipping after endoscopic mucosal resection (EMR) in the colon (33) or stomach (1), 16 after polypectomy, two for hemostasis of active bleeding, and one each for fistula closure, per-oral endoscopic myotomy mucosal closure, or anchoring a feeding tube. Complete defect closure was achieved in 32 of 33 colon EMR defects and 21 of 22 other defects. All clips were placed per labeled directions for use. In 41 patients (82.0%), prophylaxis of delayed bleeding was reported as an indication for endoscopic clipping. There were three instances of delayed bleeding. There were no device-related SAEs. The only technical difficulty was one instance of premature clip deployment. A novel TTSC with anchor prongs showed success in a range of defect closures, an acceptable safety profile, and low incidence of technical difficulties.
PubMed: 38911014
DOI: 10.1055/a-2330-9803 -
American Journal of Veterinary Research Jun 2024To determine if photobiomodulation causes a premature release of liposomal bupivacaine (LB) suspensions.
OBJECTIVE
To determine if photobiomodulation causes a premature release of liposomal bupivacaine (LB) suspensions.
ANIMALS
A 25-kg mixed breed dog cadaver euthanized for reasons unrelated to this study.
METHODS
In September 2022, a proximomedial tibial incision was made in a dog cadaver, and a tibial plateau leveling osteotomy plate was implanted. A stab incision was made one-half inch distal to the incision, and a tunnel to the plate was created prior to closure of the primary wound. A 3-cc anal sac catheter was advanced through the distal incision until the bulb rested against the face of the plate. Seven treatment groups of treatment power (watts) and total energy (joules/cm2) were defined as: A, 0.5 W, 2.0 J/cm2; B, 0.5 W, 4.0 J/cm2; C, 0.5 W, 6.0 J/cm2; D, 1.0 W, 2.0 J/cm2; E, 1.0 W, 4.0 J/cm2; F, 1.0 W, 6.0 J/cm2; and sham, 0.0 W, 0.0 J/cm2. Ten samples per group of 2 mL of LB were infused into a new catheter and treated percutaneously with a class 3b laser. All samples remained in the catheter for 12 seconds to reflect the longest treatment time. Post-treatment free bupivacaine concentrations were identified with high-performance liquid chromatography.
RESULTS
The median free bupivacaine concentration was reported as: sham, 1.89 mg/mL; A, 1.93 mg/mL; B, 2.01 mg/mL; C, 2.05 mg/mL; D, 1.92 mg/mL; E, 2.03 mg/mL; and F, 2.00 mg/mL. There were no differences in median free bupivacaine concentrations between groups (P = .988).
CLINICAL RELEVANCE
Concurrent LB and photobiomodulation are recommended during the postoperative period. The results of this proof-of-concept study suggest that concurrent use of LB and photobiomodulation may be safe, but in vivo studies at similar and stronger photobiomodulation settings are warranted.
PubMed: 38866042
DOI: 10.2460/ajvr.24.02.0041 -
Pediatrics Jun 2024A 4-month-old full-term female presented with growth faltering associated with progressive feeding difficulty, rash, abdominal distension, and developmental delays. She...
A 4-month-old full-term female presented with growth faltering associated with progressive feeding difficulty, rash, abdominal distension, and developmental delays. She was found to have disconjugate gaze, abnormal visual tracking, mixed tone, bruising, and splenomegaly on examination. Initial workup was notable for thrombocytopenia and positive cytomegalovirus (CMV) immunoglobulin G and immunoglobulin M antibodies. She initially presented to the infectious diseases CMV clinic, where she was noted to have severe malnutrition, prompting referral to the emergency department for hospital admission to optimize nutrition with nasogastric tube feeding and facilitate additional evaluation. An active CMV infection with viruria and viremia was confirmed, but elements of her presentation and workup including brain magnetic resonance imaging were not consistent with isolated CMV infection. To avoid premature diagnostic closure, a multidisciplinary workup was initiated and ultimately established her diagnosis.
PubMed: 38864107
DOI: 10.1542/peds.2023-064048 -
The Journal of Pediatric Pharmacology... Jun 2024Acetaminophen (APAP) is an alternative to indomethacin and ibuprofen for treatment of patent ductus arteriosus (PDA). The side effect profile of non-steroidal...
OBJECTIVE
Acetaminophen (APAP) is an alternative to indomethacin and ibuprofen for treatment of patent ductus arteriosus (PDA). The side effect profile of non-steroidal anti-inflammatory drugs (NSAIDs) presents enteral feeding safety concerns; however, the safety of enteral feeding on APAP is largely unknown. Optimal feeding strategies during pharmacological PDA treatment are unknown, leading to practice variation. This study aims to assess the incidence of adverse gastrointestinal (GI) outcomes in neonates treated with APAP for PDA closure while receiving enteral feedings.
METHODS
Single-center retrospective cohort study of 59 extremely low birth weight (ELBW), premature neonates who received APAP for PDA treatment divided into Low Volume (LV; ≤ 20 mL/kg/day) and High Volume (HV; > 20 mL/kg/day) enteral feeding groups. The primary outcome was the incidence of any suspected or confirmed necrotizing enterocolitis (NEC). Timing of nutrition milestones, parenteral nutrition (PN) days, and adverse outcomes (feeding intolerance, liver dysfunction, death prior to discharge) were evaluated.
RESULTS
The incidence of suspected or confirmed NEC was 19.5% in the LV group and 13.3% in the HV group (p = 0.593). The HV group reached full feeds 6 days sooner (18 vs 24 days, p = 0.024) and had fewer PN days (17 vs 23.5 days, p = 0.044) with no difference in adverse outcomes.
CONCLUSIONS
Provision of > 20 mL/kg/day of enteral feeds during APAP treatment of PDA decreased time to full feeds and PN days compared to trophic feedings (≤ 20 mL/kg/day) with no difference in adverse GI outcomes. Continuing enteral feeding during APAP PDA treatment appears safe while improving achievement of nutritional milestones.
PubMed: 38863856
DOI: 10.5863/1551-6776-29.3.278 -
MedRxiv : the Preprint Server For... May 2024The binary classification of spina bifida lesions as myelomeningocele (with sac) or myeloschisis (without sac) belies a spectrum of morphologies, which have not been...
IMPORTANCE
The binary classification of spina bifida lesions as myelomeningocele (with sac) or myeloschisis (without sac) belies a spectrum of morphologies, which have not been correlated to clinical characteristics and outcomes.
OBJECTIVE
To characterize spina bifida lesion types and correlate them with preoperative presentation and postoperative outcomes.
DESIGN
Secondary analysis of images and videos obtained during fetoscopic spina bifida repair surgery from 2020-2023.
SETTING
Fetal surgery was performed at a quaternary care center.
PARTICIPANTS
A prospective cohort of patients referred for fetal spina bifida underwent fetoscopic repair under an FDA-approved protocol. Of 60 lesions repaired, 57 had available images and were included in the analysis.
INTERVENTIONS OR EXPOSURES
We evaluated lesion morphology on high-resolution intraoperative images and videos to categorize lesions based on placode exposure and nerve root stretching.
MAIN OUTCOMES AND MEASURES
The reproducibility of the lesion classification was assessed via Kappa interrater agreement. Preoperative characteristics analyzed include ventricle size, tonsillar herniation level, lower extremities movement, and lesion dimensions. Outcomes included surgical time, need for patch for skin closure, gestational age at delivery, preterm premature rupture of membranes (PPROM), and neonatal cerebrospinal fluid (CSF) diversion.
RESULTS
We distinguished five lesion types that differ across a range of sac sizes, nerve root stretching, and placode exposure, with 93% agreement between examiners (p<0.001). Fetal characteristics at preoperative evaluation differed significantly by lesion type, including lesion volume (p<0.001), largest ventricle size (p=0.008), tonsillar herniation (p=0.005), and head circumference (p=0.03). Lesion level, talipes, and lower extremities movement did not differ by type. Surgical and perinatal outcomes differed by lesion type, including need for patch skin closure (p<0.001), gestational age at delivery (p=0.01), and NICU length of stay (p<0.001). PPROM, CSF leakage at birth, and CSF diversion in the NICU did not differ between lesion groups. Linear regression associated severity of ventriculomegaly with lesion type, but not with tonsillar herniation level.
CONCLUSIONS AND RELEVANCE
There is a distinct phenotypic spectrum in open spina bifida with differential baseline presentation and outcomes. Severity of ventriculomegaly is associated with lesion type, rather than tonsillar herniation level. Our findings expand the classification of spina bifida to reveal a spectrum that warrants further study.
PubMed: 38853851
DOI: 10.1101/2024.05.29.24308088 -
Respiratory Research Jun 2024The effect of dual systemic antibiotic therapy against Pseudomonas aeruginosa in patients with pre-existing lung disease is unknown. To assess whether dual systemic... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The effect of dual systemic antibiotic therapy against Pseudomonas aeruginosa in patients with pre-existing lung disease is unknown. To assess whether dual systemic antibiotics against P. aeruginosa in outpatients with COPD, non-cystic fibrosis (non-CF) bronchiectasis, or asthma can improve outcomes.
METHODS
Multicenter, randomised, open-label trial conducted at seven respiratory outpatient clinics in Denmark. Outpatients with COPD, non-CF bronchiectasis, or asthma with a current P. aeruginosa-positive lower respiratory tract culture (clinical routine samples obtained based on symptoms of exacerbation not requiring hospitalisation), regardless of prior P. aeruginosa-status, no current need for hospitalisation, and at least two moderate or one hospitalisation-requiring exacerbation within the last year were eligible. Patients were assigned 1:1 to 14 days of dual systemic anti-pseudomonal antibiotics or no antibiotic treatment. Primary outcome was time to prednisolone or antibiotic-requiring exacerbation or death from day 20 to day 365.
RESULTS
The trial was stopped prematurely based in lack of recruitment during the COVID-19 pandemic, this decision was endorsed by the Data and Safety Monitoring Board. Forty-nine outpatients were included in the study. There was a reduction in risk of the primary outcome in the antibiotic group compared to the control group (HR 0.51 (95%CI 0.27-0.96), p = 0.037). The incidence of admissions with exacerbation within one year was 1.1 (95%CI 0.6-1.7) in the dual antibiotic group vs. 2.9 (95%CI 1.3-4.5) in the control group, p = 0.037.
CONCLUSIONS
Use of dual systemic antibiotics for 14 days against P. aeruginosa in outpatients with chronic lung diseases and no judged need for hospitalisation, improved clinical outcomes markedly. The main limitation was the premature closure of the trial.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT03262142, registration date 2017-08-25.
Topics: Humans; Male; Female; Pseudomonas Infections; Anti-Bacterial Agents; Aged; Middle Aged; Pseudomonas aeruginosa; Denmark; Outpatients; Disease Progression; Treatment Outcome; Hospitalization; Pulmonary Disease, Chronic Obstructive
PubMed: 38844921
DOI: 10.1186/s12931-024-02860-9 -
Interventional Cardiology Clinics Jul 2024Transcatheter ductal closure has proven to be safe and effective to occlude the patent ductus arteriosus (PDA) in premature infants. We have developed a robust... (Review)
Review
Transcatheter ductal closure has proven to be safe and effective to occlude the patent ductus arteriosus (PDA) in premature infants. We have developed a robust multidisciplinary PDA program. After gaining experience performing transcatheter ductal closure in the cardiac catheterization laboratory, we transitioned to performing the procedure at the patient's bedside in the neonatal intensive care unit using echocardiographic guidance. The bedside approach has the potential to expand this therapy to patients who currently undergo expectant PDA management because of lack of availability of this therapy, and allow for earlier referral, which will reduce time of exposure to this pathologic shunt.
Topics: Humans; Ductus Arteriosus, Patent; Infant, Newborn; Infant, Premature; Cardiac Catheterization; Septal Occluder Device; Echocardiography
PubMed: 38839169
DOI: 10.1016/j.iccl.2024.02.001 -
ELife Jun 2024Ninein is a centrosome protein that has been implicated in microtubule anchorage and centrosome cohesion. Mutations in the human gene have been linked to Seckel...
Ninein is a centrosome protein that has been implicated in microtubule anchorage and centrosome cohesion. Mutations in the human gene have been linked to Seckel syndrome and to a rare form of skeletal dysplasia. However, the role of ninein in skeletal development remains unknown. Here, we describe a ninein knockout mouse with advanced endochondral ossification during embryonic development. Although the long bones maintain a regular size, the absence of ninein delays the formation of the bone marrow cavity in the prenatal tibia. Likewise, intramembranous ossification in the skull is more developed, leading to a premature closure of the interfrontal suture. We demonstrate that ninein is strongly expressed in osteoclasts of control mice, and that its absence reduces the fusion of precursor cells into syncytial osteoclasts, whereas the number of osteoblasts remains unaffected. As a consequence, ninein-deficient osteoclasts have a reduced capacity to resorb bone. At the cellular level, the absence of ninein interferes with centrosomal microtubule organization, reduces centrosome cohesion, and provokes the loss of centrosome clustering in multinucleated mature osteoclasts. We propose that centrosomal ninein is important for osteoclast fusion, to enable a functional balance between bone-forming osteoblasts and bone-resorbing osteoclasts during skeletal development.
Topics: Animals; Osteoclasts; Osteogenesis; Mice, Knockout; Mice; Nuclear Proteins; Centrosome; Osteoblasts
PubMed: 38836552
DOI: 10.7554/eLife.93457