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Clinical and Experimental... May 2024Considerable research has been focused on independent predictors of difficult laryngeal exposure (DLE) during suspension laryngoscopy. However, previous studies have...
OBJECTIVES
Considerable research has been focused on independent predictors of difficult laryngeal exposure (DLE) during suspension laryngoscopy. However, previous studies have yielded inconsistent results and conclusions. Consequently, we performed a meta-analysis of the existing literature with the aim of identifying significant parameters for a standardized preoperative DLE prediction system.
METHODS
We systematically retrieved articles from the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases up to October 2022. Data from eligible studies were extracted and analyzed using the R programming language. The effect measures included odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous variables and mean differences (MDs) with 95% CIs for continuous variables.
RESULTS
The search yielded 1,574 studies, of which 18 (involving a total of 2,263 patients) were included. Pooled analysis demonstrated that patients with DLE during microsurgery tended to be male (OR, 1.73; 95% CI, 1.16-2.57); were older (MD, 5.47 years, 95% CI, 2.44-8.51 years); had a higher body mass index (BMI; MD, 1.19 kg/m2; 95% CI, 0.33-2.05 kg/m2); had a greater neck circumference (MD, 2.50 cm; 95% CI, 1.56-3.44 cm); exhibited limited mouth opening (MD, -0.52 cm; 95% CI, -0.88 to -0.15 cm); had limited neck flexibility (MD, -10.05 cm; 95% CI, -14.10 to -6.00 cm); displayed various other anatomical characteristics; and had a high modified Mallampati index (MMI) or test score (OR, 3.37; 95% CI, 2.07-5.48).
CONCLUSION
We conducted a comprehensive and systematic analysis of the factors relevant to DLE. Ultimately, we identified sex, age, BMI, neck circumference, MMI, inter-incisor gap, hyomental distance, thyromental distance, sternomental distance, and flexion-extension angle as factors highly correlated with DLE.
PubMed: 38659242
DOI: 10.21053/ceo.2023.00023 -
Taiwan Journal of Ophthalmology 2024Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), providing a viable... (Review)
Review
Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), providing a viable alternative to penetrating keratoplasty (PK). This systematic review explores the intricacies of DALK, comparing its preoperative, intraoperative, and postoperative considerations with PK. Extensive literature searches revealed a wealth of data regarding DALK's advantages and challenges, with an emphasis on graft survival, visual outcomes, and complications. In the preoperative phase, DALK showcases its versatility, catering to a wide spectrum of patients, including those with KC and ocular surface disorders. Intraoperatively, it offers innovative techniques to address emphysema, bubble formation, and Descemet's membrane perforation, all while maintaining a strong focus on patient-centered outcomes. Postoperatively, DALK's lower rejection rates and decreased complications underscore its potential superiority over PK, although unique challenges such as graft failure from nonimmunologic factors demand vigilant management. This comprehensive review not only serves as a valuable resource for ophthalmic surgeons but also sheds light on the evolving landscape of corneal transplantation, highlighting DALK's role as a transformative force in the field.
PubMed: 38654987
DOI: 10.4103/tjo.TJO-D-23-00175 -
Cureus Mar 2024Pain management is a critical aspect of cancer treatment and palliative care, where pain can significantly impact quality of life. Chronic pain, which affects a... (Review)
Review
Pain management is a critical aspect of cancer treatment and palliative care, where pain can significantly impact quality of life. Chronic pain, which affects a significant number of people worldwide, remains a prevalent and challenging symptom for patients. While medications and psychosocial support systems play a role in pain management, surgical and radiological interventions, including cingulotomy, may be necessary for refractory cases. Cingulotomy, a neurosurgical procedure targeting the cingulate gyrus, aims to disrupt neural pathways associated with emotional processing and pain sensation, thereby reducing the affective component of pain. Although cingulotomy has shown promise in providing pain relief, particularly in patients refractory to traditional medical treatment, its use has declined in recent years due to advancements in non-destructive therapies and concerns about long-term efficacy and patient suitability. Modern stereotactic methods have enhanced the precision and safety of cingulotomy, reducing associated complications and mortality rates. Despite these advancements, questions remain regarding its long-term efficacy and suitability for patients with limited life expectancy, particularly those with cancer. A comprehensive systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, aimed at providing insights into the efficacy, potential benefits, and limitations of this neurosurgical procedure in managing intractable pain. An electronic search of PubMed, Embase, Scopus, and Web of Science was conducted with open database coverage dates. The review focused on outcomes such as pain intensity and quality of life. The inclusion criteria encompassed human studies of any age experiencing intractable cancer or non-cancer pain, with cingulotomy as the primary intervention. Various study designs were considered, including observational studies, clinical trials, and reviews focusing on pain and cingulotomy. Exclusion criteria included non-human studies, non-peer-reviewed articles, and studies unrelated to pain or cingulotomy. This review highlights the efficacy of stereotactic anterior cingulotomy in managing intractable pain, particularly when conventional treatments fail. Advanced MRI-guided techniques enhance precision, but challenges like cost and expertise persist. Studies included in this review showed significant pain relief with minimal adverse effects, although the optimal target remains debated. Neurocognitive risks exist, but outcomes are generally favorable. Expected adverse events include transient effects like urinary incontinence and confusion. Reoperation may be necessary for inadequate pain control, with a median pain relief duration of three months to a year. A double stereotactic cingulotomy appears to be safe and effective for refractory pain.
PubMed: 38650773
DOI: 10.7759/cureus.56746 -
Turkish Neurosurgery 2024To assess, and to compare the efficacy of anterior endoscopic cervical discectomy (AECD) and anterior cervical discectomy with fusion (ACDF).
AIM
To assess, and to compare the efficacy of anterior endoscopic cervical discectomy (AECD) and anterior cervical discectomy with fusion (ACDF).
MATERIAL AND METHODS
Major databases, registries, and other relevant material were screened for prospective trials directly comparing AECD and ACDF. No restrictions were imposed. Meta-analysis was not conducted due to high heterogeneity.
RESULTS
After screening a total of 1339 articles, 2 studies enrolling 225 patients were included. One of these is a randomizedcontrolled- trial, including 120 patients, with a 14% lost to follow-up, showing no statistically significant differences in clinical outcomes according to the visual analogue scale (VAS) of the neck/arm and the North American Spine Society criteria regarding pain/neurological status. Radiological follow-up showed no adjacent-segment disease, with both groups presenting a statistically non-significant progression of a pre-existing adjacent-disc degeneration, and no difference in kyphosis. Recurrence was registered in 7.4% and 6.1% of patients who underwent AECD and ACDF, respectively. No statistically apparent differences in complications were observed. The second is a cohort study, including 135 patients with a 14.8% lost to follow-up. No statistically significant difference was found in clinical outcomes assessed using the VAS of the neck/arm and the neck disability index. No radiological data were provided. Recurrence was reported in 4% and 2% of patients in the AECD and ACDF group, respectively. No remarkable differences in complications were reported. Both studies reported that the surgical time was statistically shorter in AECD.
CONCLUSION
A definitive conclusion cannot be drawn. Single-level AECD seems to have results equivalent to ACDF, presenting even some benefits. Technical limitations combined with required surgical skills and experience should be considered. We recommend cautious employment in anticipation of future updates.
Topics: Humans; Diskectomy; Spinal Fusion; Cervical Vertebrae; Endoscopy; Treatment Outcome; Intervertebral Disc Degeneration
PubMed: 38650569
DOI: 10.5137/1019-5149.JTN.44424-23.2 -
Cureus Mar 2024Anterior cruciate ligament (ACL) injury is very common, especially in young athletic individuals who injure themselves during sports involving pivoting actions.... (Review)
Review
Anterior cruciate ligament (ACL) injury is very common, especially in young athletic individuals who injure themselves during sports involving pivoting actions. Management options include conservative management, which involves progressive physical therapy, educating the patient on how to prevent instability, and the use of a hinged knee brace. Surgical management involves reconstruction of the torn ligament using an autograft or an allograft and ACL repair where the torn ligament is affixed back to the tibia or femur. The choice of management depends on the severity of the injury, other injuries in associated structures, the level of fitness, and the athletic goals of the patient. Many studies exist on the management choice of ACL injury, but no clear consensus prevails. This study will examine the effectiveness of conservative versus surgical management. A literature review will be performed to identify appropriate papers which compare and evaluate the two approaches. A literature search for randomized controlled trials (RCTs) and cohort studies comparing the conservative to surgical management of ACL injury was conducted on PubMed, Scopus, and Web of Science. Patient eligibility criteria included individuals older than 15 with an isolated, recent ACL injury diagnosis via an appropriate clinical test, MRI, or arthroscopy. Studies were eligible if they were using appropriate surgical or conservative methods, as mentioned previously, and measuring results via appropriate scores, tools, and methods that will be presented below. The follow-up timeline would be from presentation time until at least two years. Five papers were found to be eligible. Overall, these papers included 462 patients. Two studies measuring overall knee symptoms, function, and sports activities using the International Knee Documentation Committee Subjective Knee Form (IKDC) score found that the operated group had a significantly higher score. The other two studies measured overall knee function and health using the Tegner & Lysholm and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores. In both papers, no significant difference was found between the two groups. Regarding Tegner's activity score, only one paper had significant findings. A significantly longer period to return to sports activities was observed in the operative group. Stability was significantly higher in all papers in the operated group. Osteoarthritis was measured using different tools in each paper. Only one paper found a significantly higher risk in the operated group. Only one paper indicated significantly more complications in the operated group regarding side effects. Overall, very few differences were observed between the two treatment groups. The most significant differences observed were the higher stability and the longer recovery period in patients undergoing surgery. Large RCTs following patients for enough time are needed to prove if surgical treatment offers significant benefits over conservative treatment.
PubMed: 38646275
DOI: 10.7759/cureus.56532 -
Urology Case Reports May 2024Bladder duplication (BD) is a rare malformation that is often associated to other anomalies. We report a newborn diagnosed with BD in the sagittal plane, associated to...
Bladder duplication (BD) is a rare malformation that is often associated to other anomalies. We report a newborn diagnosed with BD in the sagittal plane, associated to persistent urogenital sinus (UGS), given the opening of the vagina immediately below the bladder neck. It is the fourth time this association is reported. Surgical repair was made: both bladders were joined, the common channel was left as urethra and the vagina was descended with a vaginoplasty with an intestinal segment. She also presented an anterior anus, that required posterior mobilization. The patient is currently 3 years old with good sphincter control.
PubMed: 38645772
DOI: 10.1016/j.eucr.2024.102736 -
NeuroImage Jun 2024This systematic review investigates how prefrontal transcranial magnetic stimulation (TMS) immediately influences neuronal excitability based on oxygenation changes... (Review)
Review
This systematic review investigates how prefrontal transcranial magnetic stimulation (TMS) immediately influences neuronal excitability based on oxygenation changes measured by functional magnetic resonance imaging (fMRI) or functional near-infrared spectroscopy (fNIRS). A thorough understanding of TMS-induced excitability changes may enable clinicians to adjust TMS parameters and optimize treatment plans proactively. Five databases were searched for human studies evaluating brain excitability using concurrent TMS/fMRI or TMS/fNIRS. Thirty-seven studies (13 concurrent TMS/fNIRS studies, 24 concurrent TMS/fMRI studies) were included in a qualitative synthesis. Despite methodological inconsistencies, a distinct pattern of activated nodes in the frontoparietal central executive network, the cingulo-opercular salience network, and the default-mode network emerged. The activated nodes included the prefrontal cortex (particularly dorsolateral prefrontal cortex), insula cortex, striatal regions (especially caudate, putamen), anterior cingulate cortex, and thalamus. High-frequency repetitive TMS most consistently induced expected facilitatory effects in these brain regions. However, varied stimulation parameters (e.g., intensity, coil orientation, target sites) and the inter- and intra-individual variability of brain state contribute to the observed heterogeneity of target excitability and co-activated regions. Given the considerable methodological and individual variability across the limited evidence, conclusions should be drawn with caution.
Topics: Humans; Transcranial Magnetic Stimulation; Prefrontal Cortex; Magnetic Resonance Imaging; Spectroscopy, Near-Infrared; Oxygen; Brain Mapping; Brain
PubMed: 38636640
DOI: 10.1016/j.neuroimage.2024.120618 -
Spine Surgery and Related Research Mar 2024Perioperative cerebrovascular accidents (CVAs) related to spine surgery, although rare, can lead to significant disabilities. More studies on spine surgeries are...
INTRODUCTION
Perioperative cerebrovascular accidents (CVAs) related to spine surgery, although rare, can lead to significant disabilities. More studies on spine surgeries are required to identify those at risk of perioperative CVAs. The characteristics and outcomes of patients that experienced CVAs during spine surgery were assessed through a retrospective descriptive study and meta-analysis.
METHODS
Patients aged ≥18 years who underwent spine surgery under general anesthesia at a hospital between April 2011 and March 2023 were examined. Of the 2,391 initially identified patients, 2,346 were included after excluding 45 who underwent debridement for surgical site infections. Subsequently, a meta-analysis including the present retrospective descriptive study was conducted. Databases such as PubMed and Google Scholar were searched for original peer-reviewed articles written in English.
RESULTS
Of the 2,346 patients, 4 (0.17%) (three men, one woman) exhibited perioperative CVAs associated with spine surgery. The CVAs were diverse in nature: one case of cerebral hemorrhage resulting from dural injury during posterior occipitocervical fusion, two cases of cerebral infarctions after lumbar laminectomy and anterior thoracic fusion due to anticoagulant discontinuation, and one case of posterior reversible encephalopathy syndrome following microscopic lumbar discectomy due to gestational hypertension. The subsequent meta-analysis included three studies (n=186,860). It showed several risk factors for perioperative CVAs, including cervical level (pooled odds ratio [OR]=1.33), hypertension (pooled OR=2.27), atrial fibrillation (pooled OR=8.78), history of heart disease (pooled OR=2.47), and diabetes (pooled OR=2.13).
CONCLUSIONS
It was speculated that the potential risk factors for the four perioperative CVA cases of spine surgery in this retrospective descriptive study were intraoperative dural injury, preoperative anticoagulant discontinuation, and gestational hypertension history. The meta-analysis revealed that cervical spine surgery, hypertension, atrial fibrillation, heart disease, and diabetes increased the CVA risk. This highlights the need for risk assessment, preoperative optimization, and postoperative care to reduce spine surgery-associated perioperative CVAs.
PubMed: 38618211
DOI: 10.22603/ssrr.2023-0213 -
Heart, Lung & Circulation Apr 2024The optimal management strategy for significant unprotected ostial left anterior descending artery (LAD) disease remains undefined. Merits of the two most common...
BACKGROUND
The optimal management strategy for significant unprotected ostial left anterior descending artery (LAD) disease remains undefined. Merits of the two most common percutaneous approaches are considered in this quantitative synthesis.
METHOD
A meta-analysis was performed to compare ostial stenting (OS) and crossover stenting (CS) in the treatment of unprotected ostial LAD stenosis. The primary outcome is the disparity in target lesion revascularisation (TLR). The Mantel-Haenszel method was employed with random effect model, chosen a priori to account for heterogeneity among the included studies.
RESULTS
Seven studies comprising 1,181 patients were included in the analyses. Of these, 482 (40.8%) patients underwent CS. Overall, there was a statistically significant trend in favour of CS (odds ratio 0.51, 95% confidence interval 0.30-0.86, p=0.01) with respect to the rate of TLR at follow-up. This remained true when TLR involving the left circumflex artery (LCx) was considered, even when there was a greater need for unintended intervention to the LCx during the index procedure (odds ratio 6.68, 95% confidence interval: 1.69-26.49, p=0.007). Final kissing balloon inflation may reduce the need for acute LCx intervention. Imaging guidance appeared to improve clinical outcomes irrespective of approach chosen.
CONCLUSIONS
In the percutaneous management of unprotected ostial LAD disease, CS into the left main coronary artery (LMCA) appeared to reduce future TLR. Integration of intracoronary imaging was pivotal to procedural success. The higher incidence of unintended LCx intervention in the CS arm may be mitigated by routine final kissing balloon inflation, although the long-term implication of this remains unclear. In the absence of randomised trials, clinicians' discretion remains critical.
PubMed: 38614944
DOI: 10.1016/j.hlc.2024.02.006 -
Journal of Clinical Medicine Mar 2024Minimally invasive surgical (MIS) techniques have gained popularity as a safe and effective alternative to open surgery for degenerative, traumatic, and metastatic... (Review)
Review
Minimally invasive surgical (MIS) techniques have gained popularity as a safe and effective alternative to open surgery for degenerative, traumatic, and metastatic spinal pathologies. In adolescent idiopathic scoliosis, MIS techniques comprise anterior thoracoscopic surgery (ATS), posterior minimally invasive surgery (PMIS), and vertebral body tethering (VBT). In the current systematic review, the authors collected and analyzed data from the available literature on MIS techniques in AIS. The articles were shortlisted after a thorough electronic and manual database search through PubMed, EMBASE, and Google Scholar. The authors included 43 studies for the review; 14 described the outcomes with ATS, 13 with PMIS, and 16 with VBT. While the efficacy of the ATS approach is well-established in terms of comparable coronal and sagittal correction to posterior spinal fusion, the current use of ATS for instrumented fusion has become less popular due to a steep learning curve, high pulmonary and vascular complication rates, implant failures, and increased non-union rates. PMIS is an effective alternative to the standard open posterior spinal fusion, with a steep learning curve and longer surgical time being potential disadvantages. The current evidence, albeit limited, suggests that VBT is an attractive procedure that merits consideration in terms of radiological correction and clinical outcomes, but it has a high complication and re-operation rate, while the most appropriate indications and long-term outcomes of this technique remain unclear.
PubMed: 38610778
DOI: 10.3390/jcm13072013