This study compared the efficacy of injectable collagenase versus partial fasciectomy in treating Dupuytren's contracture. 15 patients (33 rays) were divided into two groups: Group A underwent partial fasciectomy (26 rays) while Group B was treated with collagenase injections (7 rays). The collagenase treatment was found to be safe and effective, with contractures improving significantly and few complications. However, recurrence and failure rates were slightly higher compared to surgery. While collagenase injection is a good alternative to surgery, its higher cost should be considered, especially in developing countries.
Novel Technique Combining Tissue and Mesh Repair for Umbilical Hernia in AdultsKETAN VAGHOLKAR
This document describes a new surgical technique for repairing umbilical hernias in adults that combines tissue repair with mesh reinforcement. The study evaluated 20 adult patients who underwent the novel procedure. Key aspects of the technique include reconstructing the abdominal wall midline using flaps of anterior rectus sheath, placing a mesh over the newly formed midline for reinforcement, and approximating surrounding tissues. None of the 20 patients who underwent the procedure developed a hernia recurrence in the follow-up period ranging from 10 to 18 months. The authors conclude that this combined tissue and mesh repair technique provides an effective option for umbilical hernia repair in adults.
This study compared two methods of fixing polypropylene mesh during open inguinal hernia repair surgery: fibrin glue fixation versus suture fixation. The study included 60 patients undergoing unilateral inguinal hernia repair who were divided into two groups. The results showed that surgery time was significantly shorter when using fibrin glue fixation compared to suture fixation. Patients who received fibrin glue fixation also reported significantly less pain in the first post-operative day, first post-operative week, and one month after surgery. There were no significant differences in complications between the two groups. The study concluded that fibrin glue provided an effective alternative to sutures for fixing mesh with benefits including shorter surgery time and less post-operative pain.
REOPERATIONS AFTER MINIMALLY INVASIVE LUMBAR SPINE SURGERYYunus Aydın
This document summarizes a study on reoperations after minimally invasive lumbar spine surgery due to recurrent disc herniations. The study included 914 patients who underwent microdiskectomy for lumbar disc herniations and 1063 patients who underwent bilateral decompression via a unilateral approach for degenerative lumbar spinal stenosis, with a mean follow-up time of 14 years. The results showed low recurrence rates of 3.8% for disc herniations and 1.2% for disc herniations with stenosis. Clinical outcomes improved significantly based on Oswestry Disability Index and SF-36 scores. The techniques allowed safe decompression while preserving stability, resulting in reduced symptoms and improved quality of life.
Presented at the American Association of Neurosurgery 2011 annual meeting by Prof. Dr. Yunus AYDIN:
Preservation of segmental motion with anterior contralateral cervical microdiskectomy and interbody fat, a prospective study
Anatomical Glenoid Reconstruction for Recurrent Anterior Glenohumeral Instabi...Peter Millett MD
Eleven cases of traumatic recurrent anterior instability that required bony reconstruction for severe anterior glenoid bone loss were reviewed. In all cases, the length of the anterior glenoid defect exceeded the maximum anteroposterior radius of the glenoid based on preoperative assessment by 3-dimensional CT scan. Surgical reconstruction was performed using an intra-articular tricortical iliac crest bone graft contoured to reestablish the concavity and width of the glenoid. The graft was fixed with cannulated screws in combination with an anterior-inferior capsular repair. For more shoulder surgery and instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
The document discusses challenges with delivering drugs to chondrocytes within joints for treating chronic conditions like osteoarthritis. Direct injection of drugs is ineffective as materials diffuse out of joints quickly. Avidin shows promise as a delivery system as it can penetrate and bind within cartilage, slowly releasing attached drugs over long periods. A recent study conjugated the anti-inflammatory drug dexamethasone to avidin, finding it protected cartilage better than direct dexamethasone in tests, indicating avidin may help drugs effectively target chondrocytes. This research could lead to new treatment approaches for joint diseases if validated in animal models and clinical trials.
Goodwin efetividade da fisio supervisionada num período precGustavo Resek Borges
This randomized controlled trial evaluated the effectiveness of supervised physical therapy plus a home program versus a home program alone for 84 patients who underwent arthroscopic partial meniscectomy. Patients were randomly assigned to receive either 6 weeks of supervised physical therapy plus a home program or just a home program. Outcome measures were collected at 5 and 50 days post-surgery and found no differences between the groups, indicating that the supervised physical therapy used in this study provided no additional benefits in the early period after uncomplicated arthroscopic partial meniscectomy compared to a home program alone.
Novel Technique Combining Tissue and Mesh Repair for Umbilical Hernia in AdultsKETAN VAGHOLKAR
This document describes a new surgical technique for repairing umbilical hernias in adults that combines tissue repair with mesh reinforcement. The study evaluated 20 adult patients who underwent the novel procedure. Key aspects of the technique include reconstructing the abdominal wall midline using flaps of anterior rectus sheath, placing a mesh over the newly formed midline for reinforcement, and approximating surrounding tissues. None of the 20 patients who underwent the procedure developed a hernia recurrence in the follow-up period ranging from 10 to 18 months. The authors conclude that this combined tissue and mesh repair technique provides an effective option for umbilical hernia repair in adults.
This study compared two methods of fixing polypropylene mesh during open inguinal hernia repair surgery: fibrin glue fixation versus suture fixation. The study included 60 patients undergoing unilateral inguinal hernia repair who were divided into two groups. The results showed that surgery time was significantly shorter when using fibrin glue fixation compared to suture fixation. Patients who received fibrin glue fixation also reported significantly less pain in the first post-operative day, first post-operative week, and one month after surgery. There were no significant differences in complications between the two groups. The study concluded that fibrin glue provided an effective alternative to sutures for fixing mesh with benefits including shorter surgery time and less post-operative pain.
REOPERATIONS AFTER MINIMALLY INVASIVE LUMBAR SPINE SURGERYYunus Aydın
This document summarizes a study on reoperations after minimally invasive lumbar spine surgery due to recurrent disc herniations. The study included 914 patients who underwent microdiskectomy for lumbar disc herniations and 1063 patients who underwent bilateral decompression via a unilateral approach for degenerative lumbar spinal stenosis, with a mean follow-up time of 14 years. The results showed low recurrence rates of 3.8% for disc herniations and 1.2% for disc herniations with stenosis. Clinical outcomes improved significantly based on Oswestry Disability Index and SF-36 scores. The techniques allowed safe decompression while preserving stability, resulting in reduced symptoms and improved quality of life.
Presented at the American Association of Neurosurgery 2011 annual meeting by Prof. Dr. Yunus AYDIN:
Preservation of segmental motion with anterior contralateral cervical microdiskectomy and interbody fat, a prospective study
Anatomical Glenoid Reconstruction for Recurrent Anterior Glenohumeral Instabi...Peter Millett MD
Eleven cases of traumatic recurrent anterior instability that required bony reconstruction for severe anterior glenoid bone loss were reviewed. In all cases, the length of the anterior glenoid defect exceeded the maximum anteroposterior radius of the glenoid based on preoperative assessment by 3-dimensional CT scan. Surgical reconstruction was performed using an intra-articular tricortical iliac crest bone graft contoured to reestablish the concavity and width of the glenoid. The graft was fixed with cannulated screws in combination with an anterior-inferior capsular repair. For more shoulder surgery and instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
The document discusses challenges with delivering drugs to chondrocytes within joints for treating chronic conditions like osteoarthritis. Direct injection of drugs is ineffective as materials diffuse out of joints quickly. Avidin shows promise as a delivery system as it can penetrate and bind within cartilage, slowly releasing attached drugs over long periods. A recent study conjugated the anti-inflammatory drug dexamethasone to avidin, finding it protected cartilage better than direct dexamethasone in tests, indicating avidin may help drugs effectively target chondrocytes. This research could lead to new treatment approaches for joint diseases if validated in animal models and clinical trials.
Goodwin efetividade da fisio supervisionada num período precGustavo Resek Borges
This randomized controlled trial evaluated the effectiveness of supervised physical therapy plus a home program versus a home program alone for 84 patients who underwent arthroscopic partial meniscectomy. Patients were randomly assigned to receive either 6 weeks of supervised physical therapy plus a home program or just a home program. Outcome measures were collected at 5 and 50 days post-surgery and found no differences between the groups, indicating that the supervised physical therapy used in this study provided no additional benefits in the early period after uncomplicated arthroscopic partial meniscectomy compared to a home program alone.
1) The article classifies post-herniorrhaphy pain syndromes and proposes a new classification system put forth by Loos and colleagues.
2) The classification aims to better understand the basic causes of chronic post-herniorrhaphy pain in order to develop standardized assessment and management protocols.
3) The new system identifies neuropathic pain from nerve damage as the primary underlying cause and may help guide future pain treatment approaches.
The document discusses ophthalmic indications for gamma knife surgery including uveal melanomas, eye metastases, advanced glaucoma, age-related macular degeneration, hemangioblastoma, angioreticuloma, and pseudotumors. It describes immobilizing the eye using retrobulbar anesthetic block and fixation of the four rectus muscles to the frame. It notes gamma knife radiosurgery is usually performed in the prone position and reports a 94% 3-5 year tumor control rate for uveal melanoma when prescribing 40 Gy to the 50% isodose line. It also mentions assessing accuracy in ophthalmic radiosurgery and avoiding complications such as chronic painful glaucoma refractory
This study compared the efficacy of treating dorsal wrist ganglions with aspiration and triamcinolone injection versus surgical excision. 60 patients were randomly assigned to either treatment. Successful resolution was achieved in both groups. The aspiration/injection group reported mild pain in 23.3% of patients and a 6.66% recurrence rate over 2 years. The surgical excision group reported moderate postoperative pain requiring analgesics for 5 days and a 16.66% recurrence rate. The study concluded aspiration/injection is superior due to lower recurrence and morbidity rates.
This document describes a randomized clinical trial that aims to compare the incidence of blocking all three nerves (femoral, lateral femoral cutaneous, and obturator nerves) when performing ultrasound-guided fascia iliaca compartment block using either a supra-inguinal approach versus an infra-inguinal approach. Sixty patients undergoing lower limb surgery will be randomly assigned to receive the block using one of the two approaches. The primary outcome is the incidence of a three-nerve block, while secondary outcomes include time of nerve block onset and distance of injection point from the inguinal ligament.
More harm than benefit of perioperative dexamethasone on recovery following ...Dibya Falgoon Sarkar
1. A prospective double-blind randomized trial found that perioperative dexamethasone provided minor pain relief but significantly increased insulin requirements and risk of infections in patients undergoing reconstructive head and neck cancer surgery.
2. Dexamethasone did not accelerate recovery or shorten hospital stay and its use in head and neck cancer reconstruction provided no clear clinical benefits while increasing complications.
3. A randomized controlled trial of corticosteroids after transoral robotic surgery found extended perioperative dexamethasone was safe and may allow for earlier improvement in diet consistency and decreased hospital stay, though it minimally affected postoperative pain.
Lipedemia and periodontitis article journal of arab boardWalid Altayeb
Recent studies have proven that periodontal disease can produce numerous changes in systemic health changing the blood chemistry with a rise in proteins and lipids in the serum. These factors explain, at least in part, the probable association between periodontitis and the susceptibility for certain systemic diseases, such as the increased risk of cardiovascular disease. The aim of this study was to evaluate the association between pathologic levels of lipidemia and periodontitis.
National Skin Centre Dermatology Research NewsletterJ W
Dr. Tey Hong Liang was awarded the NMRC TA grant for his new research study on developing alternative treatments for keloids using drug-free microneedles containing hyaluronic acid. The project aims to create a safe, easy-to-administer, and cost-effective treatment that could benefit patients with limited access to standard treatments. A/Prof Mark Tang was interviewed about an ongoing drug trial for Dupilumab, a monoclonal antibody that could be an effective alternative to steroids for treating atopic dermatitis. The newsletter provides updates on research activities at the National Skin Centre including awards, grants, recruitment needs for studies, and a farewell dinner for a departing clinical research fellow.
(October 2016) Non-operative management of medical meniscus posterior horn ro...Logan Peter
This study evaluated 52 patients with medial meniscus posterior horn root tears (MMPRTs) treated non-operatively over a mean follow-up of 5 years. The study found that 31% of patients underwent knee arthroplasty within 30 months on average. For the remaining patients, the mean subjective knee score was 61, indicating poor outcomes. Radiographic arthritis grades significantly worsened over time. Overall, 87% of patients met the criteria for treatment failure based on poor clinical or radiographic outcomes. Female patients and those with higher baseline arthritis grades had significantly worse outcomes. This study establishes that non-operative treatment of MMPRTs typically leads to poor clinical results and rapid arthritis progression.
31 title pagewithauthordetails-724-1-10-20210129buatdownload6
This document discusses the use of a pins and rubber traction frame technique to treat comminuted fractures of the proximal interphalangeal (PIP) joint in 8 patients. The technique involves inserting K-wires above and below the fracture site and connecting them with rubber bands to provide traction. All patients achieved bone union without complications. Postoperative range of motion of the PIP joint averaged 4.88-86.25 degrees and of the DIP joint averaged 4.38-86.25 degrees. The pins and rubber traction frame provides a simple, effective method for stabilizing complex PIP fractures to allow early motion and prevent joint stiffness.
Surgical approaches for condylar fractures related to facial nerve injury: de...Dibya Falgoon Sarkar
This study compared different percutaneous surgical approaches for treating condylar fractures to determine their relationship to facial nerve injury (FNI). The study found that approaches involving deep dissection beneath the marginal mandibular nerve branch (submandibular and retroparotid approaches) and the presence of a dislocated fracture were significantly associated with higher risks of FNI. In contrast, approaches involving more superficial dissection above the marginal mandibular nerve branch (transparotid, transmasseteric anteroparotid, high cervical transmasseteric anteroparotid approaches) had lower risks of FNI. The study concluded that superficial group approaches should be recommended to minimize the risk of F
1) The document provides information on the efficacy of different treatment modalities for esophageal strictures including dilation, stenting and intralesional steroid injections.
2) Data from studies show that fully covered self-expanding metal stents (SEMS) achieve clinical success in 30-66% of patients with refractory strictures, but have migration rates of 14-37%.
3) Biodegradable stents have a lower clinical success rate of 30-33% and require frequent reinterventions, but avoid issues of migration associated with metal stents.
Multimodal Behavioral Assessment After Experimental Brain TraumaInsideScientific
Corina Bondi, PhD discusses her research on experimental traumatic brain injury and the resulting cognitive deficits.
Traumatic brain injuries (TBIs) affect 2.8 million individuals in the United States each year. Moreover, 500,000 yearly emergency room visits are attributed to childhood-acquired brain trauma, while the elderly also constitute another high-risk population segment due to falls, with patients enduring long-lasting cognitive, physical, or behavioral effects. Impaired attention is central to the cognitive deficits associated with long-term sequelae for many TBI survivors. Considering that cognitive deficits are often assessed using multi-domain neuropsychological cognitive battery tests, Dr. Bondi’s group employed, for the first time, multimodal approaches to determine higher-order attentional capabilities after experimental TBI in rats. Their studies aimed to investigate complex cognitive deficits in adolescent and adult male and female rats subjected to frontal or parietal lobe injuries. Higher-order attentional testing will advance the understanding of long-term cognitive impairments in survivors of brain trauma and may provide reliable avenues towards developing more suitable therapeutic approaches.
Key Topics Include:
Cognitive functioning can be assessed via multiple test modalities in rodents, similar to the clinical setting.
Multiple domains of complex, higher-order cognitive functioning (sustained attention, behavioral flexibility, goal-directed behavior) are mediated by the frontal lobe in rodents in a similar fashion to the human brain, with long-lasting alterations after brain trauma occurring regardless of sex.
Differences between multiple classes of pharmacotherapies employed to restore neurobehavioral and cognitive performance after traumatic brain injury, such as antidepressants and cholinergic drugs.
2021 KSCTVA Regional Anesthesia for Thoracic Surgery부휘 홍
This document summarizes different regional anesthesia techniques for thoracic surgery. It finds that thoracic paravertebral block (TPVB) and serratus plane block (SPB) provide comparable analgesic efficacy to thoracic epidural analgesia with lower risks of complications. Network meta-analyses found that SPB, ESPB, and intercostal nerve block may provide superior pain relief compared to TPVB or controls for thoracic surgeries. The document also reviews sonoanatomy, approaches, volumes, and catheter techniques for TPVB, erector spinae plane block (ESPB), and SPB.
Percutaneous Discectomy by Dr Ashok JadonAshok Jadon
The document discusses the history and use of percutaneous discectomy to treat discogenic back pain. It notes that Lyman Smith introduced chemonucleolysis in 1963 and Kambin performed nucleotomy through a cannula in 1973. Hijikata published results in 1975 using a 7mm cannula for percutaneous discectomy, reporting a 75% satisfactory outcome. It then presents a case study of a 43-year-old male with severe back pain radiating to his left lower limb who was not improving with conservative care and was reluctant to have surgery, making him a candidate for percutaneous discectomy.
Corseting: A new technique for the management of diffuse venous malformations...Dibya Falgoon Sarkar
1) The study introduces the "corset suturing" technique for treating large diffuse venous malformations in the head and neck region. Corset suturing involves continuous suturing that incorporates the lesion and strangulates the vessels to induce occlusion.
2) The technique was performed on 90 patients with non-cutaneous venous malformations. Most lesions resolved within 4-8 weeks with minimal complications and good cosmetic outcomes.
3) While corset suturing provides an effective and low-cost alternative treatment, the study had limitations as a retrospective study without controls to fully evaluate the technique.
These slides are from versions of a talk I gave at ESTRO in 2014 and again in Lille in 2015.
The talk aims to explain the importance of correctly defining the CTV with respect to nodes in curative radiotherapy planning.
The lecture makes some important points about the function of lymph glands and their potential to act as stem cell 'rests' for malignant cells: this fact might explain whilst lymph node failure rates don't necessarily equate to disease failure rates.
The lecture then goes on to emphasise the utility of the best imaging technologies may more accurately identify involved nodes.
Shrinking fields with confidence may be the best way to reduce radiation toxicity.
The document summarizes a journal club discussion on autologous chondrocyte implantation (ACI) for treating articular cartilage defects in the knee. It provides details on the ACI procedure, which involves harvesting cartilage cells from a patient's knee, growing them in culture, and implanting them back into the defect using a periosteal patch or collagen membrane. The document compares ACI to other cartilage repair techniques like microfracture and drilling, finding ACI can regenerate hyaline-like cartilage while other techniques only produce fibrocartilage with limited lifespan. Rehabilitation guidelines and long-term assessment of ACI grafts via MRI, biopsy and arthroscopy are also summarized.
The document discusses the debate around whether mesh should be tacked or not during laparoscopic hernia repair surgery. It summarizes several studies that found: 1) There was no difference in hernia recurrence rates whether the mesh was tacked or not. 2) Patients who did not have their mesh tacked experienced less post-operative pain and required fewer pain medications. 3) Tacking the mesh increased the cost and time of the surgery without providing clinical benefits. Therefore, the document concludes that laparoscopic hernia repair can be performed safely without the routine use of mesh fixation devices.
Special Surgical Technique For Knee ArthroplastyApollo Hospitals
Seriously owing to the intense scarcity of trial studies, clin-
ical research & literature, evidence based clinical guidelines
are not available to guide physiotherapy rehabilitation post
total knee arthroplasty. In order to propagate evidence
based practice guidelines & uniformity in patient’s care,
well-designed clinical trials are required to identify cost
a
effective rehabilitation programmes after total knee
arthroplasty.1
Less invasive surgery, especially total knee arthroplasty
is of interest to both surgeons & patients, with the primary
goal of improving early recovery parameters. Patients are
attracted more towards minimal invasive surgery with the
concept of less trauma, better cosmetic appearance &
results.
This document summarizes a study that assessed changes in nearwork-induced transient myopia (NITM) parameters and accommodative functions after 6 weeks of home-based accommodative training in 10 young adult progressing myopes. The study found that after training, several dynamic accommodative response functions improved significantly, including increased lens flipper and Hart chart rates. There was also a significant negative correlation between lens flipper rate and NITM decay duration, indicating faster decay. The training resulted in improved accommodative dynamics and a reduction in NITM, consistent with previous reports of improvement in symptomatic myopes with vision therapy.
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...DrHeena tiwari
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
1) The article classifies post-herniorrhaphy pain syndromes and proposes a new classification system put forth by Loos and colleagues.
2) The classification aims to better understand the basic causes of chronic post-herniorrhaphy pain in order to develop standardized assessment and management protocols.
3) The new system identifies neuropathic pain from nerve damage as the primary underlying cause and may help guide future pain treatment approaches.
The document discusses ophthalmic indications for gamma knife surgery including uveal melanomas, eye metastases, advanced glaucoma, age-related macular degeneration, hemangioblastoma, angioreticuloma, and pseudotumors. It describes immobilizing the eye using retrobulbar anesthetic block and fixation of the four rectus muscles to the frame. It notes gamma knife radiosurgery is usually performed in the prone position and reports a 94% 3-5 year tumor control rate for uveal melanoma when prescribing 40 Gy to the 50% isodose line. It also mentions assessing accuracy in ophthalmic radiosurgery and avoiding complications such as chronic painful glaucoma refractory
This study compared the efficacy of treating dorsal wrist ganglions with aspiration and triamcinolone injection versus surgical excision. 60 patients were randomly assigned to either treatment. Successful resolution was achieved in both groups. The aspiration/injection group reported mild pain in 23.3% of patients and a 6.66% recurrence rate over 2 years. The surgical excision group reported moderate postoperative pain requiring analgesics for 5 days and a 16.66% recurrence rate. The study concluded aspiration/injection is superior due to lower recurrence and morbidity rates.
This document describes a randomized clinical trial that aims to compare the incidence of blocking all three nerves (femoral, lateral femoral cutaneous, and obturator nerves) when performing ultrasound-guided fascia iliaca compartment block using either a supra-inguinal approach versus an infra-inguinal approach. Sixty patients undergoing lower limb surgery will be randomly assigned to receive the block using one of the two approaches. The primary outcome is the incidence of a three-nerve block, while secondary outcomes include time of nerve block onset and distance of injection point from the inguinal ligament.
More harm than benefit of perioperative dexamethasone on recovery following ...Dibya Falgoon Sarkar
1. A prospective double-blind randomized trial found that perioperative dexamethasone provided minor pain relief but significantly increased insulin requirements and risk of infections in patients undergoing reconstructive head and neck cancer surgery.
2. Dexamethasone did not accelerate recovery or shorten hospital stay and its use in head and neck cancer reconstruction provided no clear clinical benefits while increasing complications.
3. A randomized controlled trial of corticosteroids after transoral robotic surgery found extended perioperative dexamethasone was safe and may allow for earlier improvement in diet consistency and decreased hospital stay, though it minimally affected postoperative pain.
Lipedemia and periodontitis article journal of arab boardWalid Altayeb
Recent studies have proven that periodontal disease can produce numerous changes in systemic health changing the blood chemistry with a rise in proteins and lipids in the serum. These factors explain, at least in part, the probable association between periodontitis and the susceptibility for certain systemic diseases, such as the increased risk of cardiovascular disease. The aim of this study was to evaluate the association between pathologic levels of lipidemia and periodontitis.
National Skin Centre Dermatology Research NewsletterJ W
Dr. Tey Hong Liang was awarded the NMRC TA grant for his new research study on developing alternative treatments for keloids using drug-free microneedles containing hyaluronic acid. The project aims to create a safe, easy-to-administer, and cost-effective treatment that could benefit patients with limited access to standard treatments. A/Prof Mark Tang was interviewed about an ongoing drug trial for Dupilumab, a monoclonal antibody that could be an effective alternative to steroids for treating atopic dermatitis. The newsletter provides updates on research activities at the National Skin Centre including awards, grants, recruitment needs for studies, and a farewell dinner for a departing clinical research fellow.
(October 2016) Non-operative management of medical meniscus posterior horn ro...Logan Peter
This study evaluated 52 patients with medial meniscus posterior horn root tears (MMPRTs) treated non-operatively over a mean follow-up of 5 years. The study found that 31% of patients underwent knee arthroplasty within 30 months on average. For the remaining patients, the mean subjective knee score was 61, indicating poor outcomes. Radiographic arthritis grades significantly worsened over time. Overall, 87% of patients met the criteria for treatment failure based on poor clinical or radiographic outcomes. Female patients and those with higher baseline arthritis grades had significantly worse outcomes. This study establishes that non-operative treatment of MMPRTs typically leads to poor clinical results and rapid arthritis progression.
31 title pagewithauthordetails-724-1-10-20210129buatdownload6
This document discusses the use of a pins and rubber traction frame technique to treat comminuted fractures of the proximal interphalangeal (PIP) joint in 8 patients. The technique involves inserting K-wires above and below the fracture site and connecting them with rubber bands to provide traction. All patients achieved bone union without complications. Postoperative range of motion of the PIP joint averaged 4.88-86.25 degrees and of the DIP joint averaged 4.38-86.25 degrees. The pins and rubber traction frame provides a simple, effective method for stabilizing complex PIP fractures to allow early motion and prevent joint stiffness.
Surgical approaches for condylar fractures related to facial nerve injury: de...Dibya Falgoon Sarkar
This study compared different percutaneous surgical approaches for treating condylar fractures to determine their relationship to facial nerve injury (FNI). The study found that approaches involving deep dissection beneath the marginal mandibular nerve branch (submandibular and retroparotid approaches) and the presence of a dislocated fracture were significantly associated with higher risks of FNI. In contrast, approaches involving more superficial dissection above the marginal mandibular nerve branch (transparotid, transmasseteric anteroparotid, high cervical transmasseteric anteroparotid approaches) had lower risks of FNI. The study concluded that superficial group approaches should be recommended to minimize the risk of F
1) The document provides information on the efficacy of different treatment modalities for esophageal strictures including dilation, stenting and intralesional steroid injections.
2) Data from studies show that fully covered self-expanding metal stents (SEMS) achieve clinical success in 30-66% of patients with refractory strictures, but have migration rates of 14-37%.
3) Biodegradable stents have a lower clinical success rate of 30-33% and require frequent reinterventions, but avoid issues of migration associated with metal stents.
Multimodal Behavioral Assessment After Experimental Brain TraumaInsideScientific
Corina Bondi, PhD discusses her research on experimental traumatic brain injury and the resulting cognitive deficits.
Traumatic brain injuries (TBIs) affect 2.8 million individuals in the United States each year. Moreover, 500,000 yearly emergency room visits are attributed to childhood-acquired brain trauma, while the elderly also constitute another high-risk population segment due to falls, with patients enduring long-lasting cognitive, physical, or behavioral effects. Impaired attention is central to the cognitive deficits associated with long-term sequelae for many TBI survivors. Considering that cognitive deficits are often assessed using multi-domain neuropsychological cognitive battery tests, Dr. Bondi’s group employed, for the first time, multimodal approaches to determine higher-order attentional capabilities after experimental TBI in rats. Their studies aimed to investigate complex cognitive deficits in adolescent and adult male and female rats subjected to frontal or parietal lobe injuries. Higher-order attentional testing will advance the understanding of long-term cognitive impairments in survivors of brain trauma and may provide reliable avenues towards developing more suitable therapeutic approaches.
Key Topics Include:
Cognitive functioning can be assessed via multiple test modalities in rodents, similar to the clinical setting.
Multiple domains of complex, higher-order cognitive functioning (sustained attention, behavioral flexibility, goal-directed behavior) are mediated by the frontal lobe in rodents in a similar fashion to the human brain, with long-lasting alterations after brain trauma occurring regardless of sex.
Differences between multiple classes of pharmacotherapies employed to restore neurobehavioral and cognitive performance after traumatic brain injury, such as antidepressants and cholinergic drugs.
2021 KSCTVA Regional Anesthesia for Thoracic Surgery부휘 홍
This document summarizes different regional anesthesia techniques for thoracic surgery. It finds that thoracic paravertebral block (TPVB) and serratus plane block (SPB) provide comparable analgesic efficacy to thoracic epidural analgesia with lower risks of complications. Network meta-analyses found that SPB, ESPB, and intercostal nerve block may provide superior pain relief compared to TPVB or controls for thoracic surgeries. The document also reviews sonoanatomy, approaches, volumes, and catheter techniques for TPVB, erector spinae plane block (ESPB), and SPB.
Percutaneous Discectomy by Dr Ashok JadonAshok Jadon
The document discusses the history and use of percutaneous discectomy to treat discogenic back pain. It notes that Lyman Smith introduced chemonucleolysis in 1963 and Kambin performed nucleotomy through a cannula in 1973. Hijikata published results in 1975 using a 7mm cannula for percutaneous discectomy, reporting a 75% satisfactory outcome. It then presents a case study of a 43-year-old male with severe back pain radiating to his left lower limb who was not improving with conservative care and was reluctant to have surgery, making him a candidate for percutaneous discectomy.
Corseting: A new technique for the management of diffuse venous malformations...Dibya Falgoon Sarkar
1) The study introduces the "corset suturing" technique for treating large diffuse venous malformations in the head and neck region. Corset suturing involves continuous suturing that incorporates the lesion and strangulates the vessels to induce occlusion.
2) The technique was performed on 90 patients with non-cutaneous venous malformations. Most lesions resolved within 4-8 weeks with minimal complications and good cosmetic outcomes.
3) While corset suturing provides an effective and low-cost alternative treatment, the study had limitations as a retrospective study without controls to fully evaluate the technique.
These slides are from versions of a talk I gave at ESTRO in 2014 and again in Lille in 2015.
The talk aims to explain the importance of correctly defining the CTV with respect to nodes in curative radiotherapy planning.
The lecture makes some important points about the function of lymph glands and their potential to act as stem cell 'rests' for malignant cells: this fact might explain whilst lymph node failure rates don't necessarily equate to disease failure rates.
The lecture then goes on to emphasise the utility of the best imaging technologies may more accurately identify involved nodes.
Shrinking fields with confidence may be the best way to reduce radiation toxicity.
The document summarizes a journal club discussion on autologous chondrocyte implantation (ACI) for treating articular cartilage defects in the knee. It provides details on the ACI procedure, which involves harvesting cartilage cells from a patient's knee, growing them in culture, and implanting them back into the defect using a periosteal patch or collagen membrane. The document compares ACI to other cartilage repair techniques like microfracture and drilling, finding ACI can regenerate hyaline-like cartilage while other techniques only produce fibrocartilage with limited lifespan. Rehabilitation guidelines and long-term assessment of ACI grafts via MRI, biopsy and arthroscopy are also summarized.
The document discusses the debate around whether mesh should be tacked or not during laparoscopic hernia repair surgery. It summarizes several studies that found: 1) There was no difference in hernia recurrence rates whether the mesh was tacked or not. 2) Patients who did not have their mesh tacked experienced less post-operative pain and required fewer pain medications. 3) Tacking the mesh increased the cost and time of the surgery without providing clinical benefits. Therefore, the document concludes that laparoscopic hernia repair can be performed safely without the routine use of mesh fixation devices.
Special Surgical Technique For Knee ArthroplastyApollo Hospitals
Seriously owing to the intense scarcity of trial studies, clin-
ical research & literature, evidence based clinical guidelines
are not available to guide physiotherapy rehabilitation post
total knee arthroplasty. In order to propagate evidence
based practice guidelines & uniformity in patient’s care,
well-designed clinical trials are required to identify cost
a
effective rehabilitation programmes after total knee
arthroplasty.1
Less invasive surgery, especially total knee arthroplasty
is of interest to both surgeons & patients, with the primary
goal of improving early recovery parameters. Patients are
attracted more towards minimal invasive surgery with the
concept of less trauma, better cosmetic appearance &
results.
This document summarizes a study that assessed changes in nearwork-induced transient myopia (NITM) parameters and accommodative functions after 6 weeks of home-based accommodative training in 10 young adult progressing myopes. The study found that after training, several dynamic accommodative response functions improved significantly, including increased lens flipper and Hart chart rates. There was also a significant negative correlation between lens flipper rate and NITM decay duration, indicating faster decay. The training resulted in improved accommodative dynamics and a reduction in NITM, consistent with previous reports of improvement in symptomatic myopes with vision therapy.
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...DrHeena tiwari
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
Treatment of Diabetic Macular Edema with Aflibercept and Micropulse Laser (DA...haha haha
This clinical trial investigated the safety and efficacy of combining intravitreal aflibercept injections with micropulse laser treatment for diabetic macular edema. Thirty patients were randomized to receive either injections with sham laser (Group 1) or injections with micropulse laser (Group 2). Both groups showed improvements in visual acuity and macular thickness after 48 weeks, with no significant differences between groups. While micropulse laser did not reduce the number of injections needed or further improve outcomes, it also did not cause any adverse effects when combined with anti-VEGF therapy.
journal club on Combined Surgical Resective and Regenerative Therapy forAdva...Shilpa Shiv
JC on Combined Surgical Resective and Regenerative Therapy forAdvanced Peri-implantitis with Concomitant Soft Tissue Volume Augmentation: A Case Report. IJPRD 2014.
This document discusses a study on the management of intra-articular fractures of the calcaneus (heel bone) using a combined percutaneous and minimal internal fixation technique. 22 patients with this fracture were treated with minimal incision and fixation using a single cancellous screw and 2 K-wires. At follow-up of 26 months on average, all fractures had healed without complications. Patients were evaluated using the Modified Rowe Score and outcomes were rated as excellent for 10 patients, good for 10 patients, and satisfactory for 2 patients, with an average score of 80. The technique aims to minimize complications by using minimal soft tissue dissection and implants.
This document summarizes a study on using maggot debridement therapy (MDT) to treat necrotizing fasciitis. It found that among 15 patients treated with surgery, antibiotics, and MDT: 1) MDT reduced the number of surgical debridements needed, especially when started within 9 days of diagnosis; and 2) the wounds eventually healed in all patients except two who died from unrelated causes. It also describes in detail one patient's case of necrotizing fasciitis that was successfully treated with multiple debridements and 19 days of MDT.
This study evaluated the long-term results of treating chronic osteomyelitis with a single-stage surgical procedure using a bioabsorbable ceramic carrier loaded with gentamicin. 100 patients with chronic osteomyelitis were treated and followed for 4-8 years. At final follow-up, 6 patients (6%) had recurrent infection, demonstrating that 94% were infection-free with this treatment. Recurrence was not related to patient comorbidities, infection characteristics, or presence of nonunion. This single-stage protocol using local antibiotic delivery was effective for treating chronic osteomyelitis over the long-term.
Controversy in the treatment of central giant cell granuloma in search of evi...Max Fax
This study retrospectively analyzed the treatment of 30 patients with central giant cell granuloma (CGCG) of the jawbone. Patients were treated with surgical curettage, calcitonin, interferon, or a combination. Surgical curettage alone had a 29% recurrence rate. Calcitonin and combinations of calcitonin and interferon did not result in any recurrences. Some patients required additional limited surgery after pharmacological treatment to correct facial contours or remove remaining lesions, but none of these recurred. The study concludes that pharmacological treatments are effective for stabilizing or reducing CGCG tumors, with lower recurrence rates than surgery alone. Further research is still needed to determine the best pharmacological agent for individual tumors
Pettine et al treatment of discogenic back pain with autologous bmc inje...Jason Attaman
This study evaluated the safety and effectiveness of treating discogenic back pain by injecting autologous bone marrow concentrate (BMC) directly into damaged discs. Twenty-six patients received injections of their own BMC into one or two painful discs. At two years follow-up, most patients experienced significant reductions in pain and disability, with 81% avoiding back surgery. No complications occurred from the injections. The results provide preliminary evidence that BMC injections may be a safe and effective non-surgical treatment for discogenic back pain.
This study evaluated outcomes of 28 patients with intracranial meningiomas treated with hypofractionated radiosurgery. Most tumors were treated with 22.5-30 Gy delivered in 5 fractions. With a mean follow up of 32.6 months, the local tumor control rate was 100% with only one instance of marginal progression. Symptoms improved or resolved in over 66% of patients who originally presented with symptoms. Side effects occurred in 4 patients but the permanent morbidity rate was low at 3.5%. Hypofractionated radiosurgery provided high tumor control with a low risk of side effects, even for large tumors greater than 9 cm3.
Early Outcome of Discectomy with Interspinous Process Distraction Device a Re...CrimsonPublishersOPROJ
Early Outcome of Discectomy with Interspinous Process Distraction Device a Retrospective Cross-Sectional Study by Gunaseelan Ponnusamy* in Crimson Publishers: Orthopedic Research and Reviews Journal
Topical dorzolamide for macular edema in the early phase after vitrectomy and...Avaleks-Kiev
Background: The purpose of this study was to evaluate prospectively the efficacy of a topical carbonic anhydrase inhibitor in macular edema after vitrectomy.
Цель: оценка перспективы использования топического ингибитора карбоангидразы для профилактики развития макулярного отека после витрэктомии.
http://ophthalmolog.kiev.ua/
EWMA 2013 - Ep489 - Guidelines for the use of an incision management system a...EWMAConference
1. Negative pressure wound therapy (NPWT) following cardiac surgery can reduce wound complications like infection and dehiscence in high-risk patients.
2. The document outlines guidelines for using NPWT on clean, closed sternotomy incisions in patients with risk factors like obesity, diabetes, bilateral mammary artery harvesting, smoking, or fragile bone.
3. Case studies showed NPWT was effective for sternotomies in obese, fragile-boned patients and for delayed closure, reducing complications compared to untreated high-risk patients.
This study compared the success rates of traditional intraoral versus a new extraoral technique for reducing temporomandibular joint dislocations. 58 dislocation reduction attempts were randomly allocated to the two methods. The traditional intraoral method was successful in 86.2% of cases, while the new external method was only successful in 55.2% of cases, a statistically significant difference. While the external method has benefits of avoiding hand bites, the study found it had a lower success rate than the traditional intraoral approach and often required additional techniques for reduction. More research is needed to better evaluate the potential advantages and disadvantages of the new external reduction method.
“A Comparative Study of Bupivacaine with Dexamethasone and Bupivacaine with C...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses the management of carcinoma of the esophagus. It begins by outlining treatment approaches for localized versus metastatic disease, including definitive and palliative therapies. It then reviews the evolution of esophageal cancer treatment, including non-surgical approaches using radiation therapy alone or combined modality therapy, as well as surgical treatments. Several studies evaluating different treatment regimens are summarized, including the benefits of concurrent chemoradiation therapy over radiation alone. The role of preoperative chemoradiation is discussed. Techniques for radiation therapy delivery are also outlined. The document concludes by discussing palliative care approaches for esophageal cancer patients.
This document summarizes guidelines for palliative radiotherapy for bone metastases. It finds that single fraction or short fractionated regimens of 8 Gy, 20 Gy in 4 fractions, 24 Gy in 6 fractions or 30 Gy in 10 fractions provide effective pain relief with minimal side effects. Bisphosphonates or surgery do not obviate the need for radiotherapy but may be used in combination. Stereotactic body radiotherapy and radiopharmaceuticals may benefit select patients but require further study.
Negative pressure wound therapy (NPWT) is a non-invasive technique that employs negative pressure within a sealed suction system, applied to acute or chronic wounds, and promotes wound healing process through the elimination of exudate, mechanical contraction of wound edges, and stimulation of angiogenesis.
Comparison of Clinical Efficacy of Surgical Approaches for Acetabular Fracturessemualkaira
To compare the different approaches and effects of pararectus approach, modified stoppa approach and ilioinguinal approach in the treatment of acetabular fractures.
Similar to Efficacy of Injectable Collagenase in the treatment of Dupuytren’s contracture in comparison to Partial Fasciectomy (20)
Title: Otoplasty: New Modification of the Mustardé technique
Author: Mohamed A.S.M. El-Rouby, MD,
Assistant Professor of Plastic surgery, Ain Shams University, Cairo, Egypt.
Abstract
Background: one of the most established techniques for management of protruding ears is the Mustardé technique (1). Many modifications had been published for this technique; however, all these modifications started by retro-auricular incision. We modify the Mustardé technique using three retroauricular microincisions to correct several deformities of the auricular cartilage in protruding ears.
Patients and Methods: 46 patients (7unilateral, 39 bilateral) (85 ears) who were candidates for this technique, their age (25 ± 2.8 years), 38 males, 8 females. The operation time, steps, follow up sessions (2 weeks, 3, 6 and 18 months) data was recorded. Preoperative and postoperative (1,18 months) photos were compared and analyzed by custom made computer program the evaluated the results.
Results: 42 patients achieve a natural appearance. extrusion of threads occurred in 8 ears. Asymmetrical ears were noticed in 4 patients and recurrence in 11 patients. These patients were revised by Mustardé technique with retro-auricular incisions. None of the patients developed retro-auricular scars.
Conclusion: this versatile modification allows for better asthenic results of otoplasty and minimizes complications of skin incision unless cartilage and/or skin resection is needed.
This document provides information about Mohamed Ahmed El-Rouby, an assistant professor of plastic and reconstructive surgery, and summarizes his expertise in wound closure techniques. It discusses direct closure for linear wounds, skin grafts or flaps for wide area wounds and skin loss, and re-implantation for amputations. Skin grafts are described as tissue transferred without its own blood supply, while flaps have an intact vascular supply. Factors like thickness, origin, adherence and revascularization processes are reviewed for grafts. Complications and various applications of grafts and flaps for nerves, fat, tendons, cartilage, bone and more are outlined.
Gangrene is the death of body tissue due to loss of blood supply. It is caused by infection or reduced blood flow and can be dry, wet, or gas gangrene. Dry gangrene develops slowly in tissues like the feet of diabetics. Wet gangrene occurs rapidly in moist tissues and causes swelling and odor. Gas gangrene is a medical emergency caused by soil bacteria that produce tissue-damaging gases. Treatment involves antibiotics, surgery to remove dead tissue, and sometimes amputation.
This document discusses reconstruction of eyelid defects. It begins by describing the anatomy and functions of the eyelids. Eyelid defects can be anatomical, involving the structure of the eyelid, or functional, affecting eyelid movement. The objectives of reconstruction are to restore anatomical integrity, physiological function, and acceptable cosmetic appearance. Various surgical techniques are described for reconstructing different types and sizes of defects in the upper and lower eyelids. Key principles include documenting the defect, avoiding tension, and using similar tissue when possible. The timing, planning and postoperative care of reconstruction are also outlined.
This document provides information on various topics related to wound management and suturing techniques. It begins with an introduction and contact information for Dr. Mohamed Ahmed El-Rouby. It then covers topics such as sterilization, wound classification, tetanus prophylaxis, wound healing, closure techniques, suture materials and types, and various suturing methods. Diagrams are provided to illustrate different suture patterns. The document aims to be a comprehensive reference on wound management and suturing.
The document discusses copyright law and ownership. It notes that the content is copyrighted by Dr. M.A. El-Rouby from 1999 to 2009. The summary provides the key details that the content is copyrighted material and identifies the owner and timeframe of the copyright.
Liposuction causes an increase in coagulative factors in the treated area, helping to stop bleeding and allowing for minimal bleeding in additional surgery. Liposuction also leaves connections between skin and fascia intact, which is why sensation in the region is much less affected than with surgical excision that severs those connections.
Dr. Mohamed Ahmed El Rouby is a consultant of plastic and reconstruction surgery at Ain shams University in Cairo, Egypt. He can be contacted via his website www.elroubyegypt.com or by email at ELROUBYEGYPT@gmail.com. Potential patients can also reach Dr. El Rouby by phone at +20101556023 or +20126531265.
This document discusses bone structure, types, healing, and grafting. It describes that bone is composed of cells integrated into a rigid calcium framework. There are two main types of ossification - endochondral, where bone forms within cartilage templates in long bones, and membranous, where bone forms directly in flat bones. Fracture healing can occur directly through bony reconstruction or indirectly through soft and hard callus formation. Bone grafts are used for nonunions, defects, and augmentation, and work through osteogenesis, osteoinduction and osteoconduction. Autogenous grafts from sites like the iliac crest are commonly used but allografts and substitutes like BMP are also options.
Burn injuries do not just cause local skin damage, but impair the function of many organs and systems through the release of inflammatory mediators into the bloodstream. Haemofiltration is a renal replacement therapy that can remove these inflammatory mediators, as well as urea, creatinine, and toxins from patients with severe burns. Indications for its use include renal failure, sepsis, respiratory distress syndrome, and refractory electrolyte imbalances or fever. The document evaluates the efficacy of haemofiltration in removing inflammatory mediators of varying molecular weights and its role in treating systemic inflammatory response syndrome in burned patients.
This document does not contain any text to summarize. It appears to be blank or contain only formatting characters. A 3 sentence summary cannot be generated without substantive content in the source document.
This document provides an overview of systemic inflammatory response syndrome (SIRS) authored by Professor Dr. Mohamed El Rouby. It defines SIRS as a severe systemic response to a critical incidence characterized by disseminated immune activation and capillary dysfunction, which can result in organ dysfunction. The pathophysiology of SIRS involves the release of lipopolysaccharides and lipid-protein complexes from infected or burned tissues, triggering cytokine cascades and immune responses that can lead to multiple organ dysfunction syndrome if not controlled. Treatment focuses on eliminating triggers through antibiotics, wound excision, and supporting organ functions through ventilation, fluids, and inotropes.
Renal failure is a major systemic complication that can occur after severe burns. The kidneys play important roles in excretion, regulation, and endocrine functions that are disrupted in renal failure. Acute renal failure occurs most commonly due to hypovolemia, massive dead tissue, sepsis, or hypercatabolic states. It is important to provide adequate fluid resuscitation to prevent renal failure. If it occurs, management involves clinical nutrition, renal replacement therapies like hemodialysis or hemofiltration, and treating underlying issues.
Rhytidectomy, also known as a face lift, has evolved over time from early procedures that were viewed negatively to becoming more accepted. The classic facelift technique developed in the 1950s, while newer deep plane techniques emerged in the 1990s. A thorough preoperative evaluation assesses medical history, expectations, and identifies asymmetries to plan the optimal procedure. The surgery involves incisions and redistribution of the superficial musculoaponeurotic system to improve contours, while minimizing risks like hematoma and nerve injury.
- Burn injuries occur when skin comes into contact with heat, chemicals, electricity or radiation. The severity depends on the intensity and duration of exposure.
- Most burns occur in the home, especially for young children and the elderly, and are often caused by cooking or hot liquids. For teenagers, burns sometimes result from suicide attempts.
- Burn management involves three phases: emergent, acute, and rehabilitative. In the emergent phase, risks include shock, respiratory complications, and kidney problems, so large burns require fluid resuscitation, airway management, and wound care. Proper treatment helps prevent infection and scarring. Referral to a burn center is advised for severe or complicated burns.
Dr. Mohamed Ahmed Sayed Mostafa El-Rouby
Professor of Plastic and Reconstructive Surgery, Maxillofacial Surgery and Burn management - Faculty of Medicine - Ain Shams University
Nationality: Egyptian
Location: Cairo - EGYPT.
Address: Heliopolis, Cairo, Egypt.
Language: Arabic, mother language and English.
Telephone: +2-01001556023 or +2-01226531265
Fax: (+2)(02)(27716563)
Clinic Address: 107 El Hegaz Street, Heliopolis, Cairo, EGYPT
E-mail: DR.MOHAMED_ELROUBY@MED.ASU.EDU.EG ELROUBYEGYPT@ELROYBYEGYPT.COM
Website: www.elrouby-clinic.com
More from Dr. Mohamed El-Rouby دكتور محمد الروبي (18)
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Efficacy of Injectable Collagenase in the treatment of Dupuytren’s contracture in comparison to Partial Fasciectomy
1. Title: Efficacy of Injectable Collagenase in the treatment of Dupuytren’s contracture
in comparison to Partial Fasciectomy
Authors: Mohamed A. El Rouby, MD, Ahmed Abd El Salam, MD, Ahmed Gad, MD Khaled
Rizq, MD
Plastic and Reconstructive Surgery Department, Ain Shams University, Cairo, EGYPT.
Accepted: Egyptian Journal of Plastic and Reconstructive Surgery
Abstract:
Background: Dupuytren's disease as a benign fibroproliferative disease with an abnormal
slowly progressive thickening and shorting of the palmar aponeurosis leads to severe
functional limitations in the finger movements particularly of the metacarpophalangeal
(MCP) joints and/or the proximal interphalangeal (PIP) joints. The authors aimed to
evaluate the role of injectable collagenase (CCH) in the treatment of Dupuytren’s
contracture in comparison to surgical treatment.
Material and method: This study included 15 patients (33 rays), They were divided into
two groups, Group A: 26 rays underwent open fasciectomy. (10 patients) and Group B: 7
rays were treated by collagenase injection. (5 patients). Exclusion criteria for group B
were contraindications of injection of CCH. The primary efficacy variable was clinical
success, contracture correction to within 5° of normal (normal = 0°) by using goniometry.
Additional efficacy variables included the time and number of injections required to
achieve success in the primary joint. Recurrence rate and adverse effects were recorded.
Results: Initial clinical experience was recorded of 5 patients (7rays) (mean age 57 years)
and compared to previously surgically managed 10 patients (26 rays) (mean age 59
years). Of all population, 51% for little, 47% for ring, 1% for middle and 1% for index
fingers. The mean of the pre-intervention fixed flexion contracture in the MCP joint was
39° and improved to one-year postintervention 14°, and in the PIP joint 47° to 19°. In
group B one ray with no improvement at all and recurrence in one ray. Partial stretching
was achieved in one ray. No serious complications were observed after injections. In
cases of group A (26 rays) that was treated by partial fasciectomy, recurrence occurred
in 6 rays and nerve injuries as nerve division and neuropraxia occurred in 2 rays.
Conclusion: The treatment of Dupuytren's disease with injectable collagenase is safe and
effective. However, the financial aspects should be considered especially in developing
countries.
keywords
Dupuytren finger collagenase Fasciectomy
2. Introduction
Dupuytren's disease (MD) is a benign fibroproliferative disorder, named after Baron
Guillaume Dupuytren’s (1777-1835) (1, 2), with an abnormal slowly progressive
thickening and shorting of the palmar aponeurosis. The etiology of this disease remains
unclear, so far, no cure is possible. It particularly affects the metacarpophalangeal (MCP)
joints and/or the proximal interphalangeal (PIP) joints. It usually affects the ring and little
fingers. (2)
The management of the Dupuytren's disease can be done with different modalities. The
aim of all previously described therapeutic procedures is to restore normal hand function.
Although surgical procedures (partial fasciectomy and fasciotomy) are still the standard,
the collagenase Clostridium histolyticum (CCH) has been approved as safe and effective
treatment option for several years. This enzymatic substance can cleave peptide bonds
and degrade collagens (all human collagen types). It has the advantages of the treatment
of older patients with co-morbidities, an earlier return to work, eliminate the risks of
surgery(3-11).
However, it should also be noted that the results of collagenase treatment of isolated
MCP contractures are significantly better than isolated PIP contractures or combined
MCP / PIP contractures. Also, repeated injections of collagenase appear to be safe and
effective despite the patient's antibody production because of repeated exposure. In a
case report from a patient who received 15 injections over 4 years, it was found that the
effect was still good in the MCP joint but slightly decreased in the PIP (12-15).
In Egypt, the commercially available collagenases (Xiapex®, 0.9 mg vial, Swedish
Orphan Biovitrum Ltd., Sweden or Xiaflex 0.9 mg vial, Endo International plc) are a
mixture, which is comprised mostly of interstitial collagen types I and III (16, 17).
The most common complications of this non-surgical technique are swelling, effusion,
hematoma or pain. Most of these adverse effects are mild or moderate and self-limiting
within an average of 10 days. Regarding the financial aspects of collagenase treatment,
another disadvantage of this procedure is the higher cost that could be 200 up to 400
USD per vial (18-20).
In a review by Chen et al. in 2011, compared the recurrence rates of surgical versus Non-
surgical procedures showed. It was significantly higher in needle aponeurotomy than in
open partial fasciectomy, and in open partial fasciectomy also appeared to be significantly
higher than in CCH injection (18).
In 2013, the safety and efficacy of CCH injections were explored again in two studies. A
total of 879 joints in 587 patients at 34 institutions were treated in the study. The treatment
at an early stage is more beneficial. In 57% of the patients treatment was successful (0-
5 ° extension within 30 days), with more improvement in MCP than PIP joints (70 vs.
37%)(5). The recurrence rate was comparable to standard surgical procedures. (21)
3. For the treatment of Dupuytren's related disease as Peyronie's disease, the use of CCH
is both effective and safe by injection of CCH directly into the tunica albuginea (22).
In this study, we aimed to evaluate the efficacy of injectable collagenase (Xiapex®, 0.9
mg vial, Pfizer Limited, Kent, UK) in the treatment of Dupuytren’s contracture in
comparison to traditional partial fasciectomy.
Material and Methods
This study included 15 patients (33 rays), (4 patients with 1 ray, 6 patients with 2 rays 3
patients with 3 rays, 2 patients with 2 rays) with flexion deformities of the MCP and/or PIP
joints of 20° or greater. Their age ranged from 40 to 65 years. They were divided into two
groups:
Group A: 26 rays underwent open fasciectomy. (10 patients)
Group B: 7 rays were treated by collagenase injection. (5 patients)
Exclusion criteria for group B were contraindications of injection of CCH as pregnancy,
hypersensitivity to collagenase or patients uses anticoagulant.
All the patients’ results were recorded at 3rd, 6th and 18th moths. The primary efficacy
variable was clinical success, contracture correction to within 5° of normal (normal = 0°)
by using goniometry. Additional efficacy variables included the time and number of
injections required to achieve success in the primary joint. Recurrence rate and adverse
effects were recorded. Common side effects include local swelling, redness, or pain at
the site of puncture was also recorded.
Injection Procedure:
After injection of local anesthetic (Lidocaine 1:200000), 0.3 mg per injection of Xiapex®
(0.9 mg vial, Pfizer Limited, Kent, UK) (23) was injected into the palpable cord. After 24 –
72 hours, we perform finger extension procedure to facilitate cord disruption for
approximately 10-20 seconds. If the first attempt to extend the finger is unsuccessful, a
second and a third attempt can be made at intervals of 5-10 minutes each without
increasing the force. The patients were instructed to use splint for 10 days with active and
passive extension exercises. Injection was repeated after Four weeks, if the MCP or PIP
contracture remains, up to a maximum of 3 injections in the same strand.
4. Results
Initial clinical experience was recorded of 5 patients (7rays) (4 males, 1 female, mean
age 57 [range 40-61] years) (Fig.1,2) and compared to previously surgically managed 10
patients (26 rays) (7 males, 3 females mean age 59 [range 42 – 65] years) (Fig. 3,4)
.(Table 1) Of all population, 51% were treated for little fingers, 47% for ring fingers, 1%
for middle fingers and 1% for index fingers.
Figure 1: Pre and 6 months
after injection (Group B)
Figure 2: Lateral view show
improvement of flexion
deformity of left PIP joint of ring
finger from 35° to 15°.
Figure 3: Preoperative and intraoperative of partial fasciectomy (Group A)
5. Table 1: number of treated rays in each group:
Group A: 26 rays underwent open fasciectomy. (10 patients)
(1 patient →1 ray 4 patients →2 rays 3 patients →3 rays 2 patients →2 rays)
Group B: 7 rays were treated by collagenase injection. (5 patients)
(3 patients →1 ray 2 patient →2 rays)
A successful strand solution was defined as achieving 0-5 ° extension of the affected joint.
This was achieved in all group B cases except one ray with no improvement at all and
recurrence in one ray. Partial stretching was achieved in one ray.
The mean of the pre-intervention fixed flexion contracture in the MCP joint was 39° and
improved to one-year postintervention 14°, and in the PIP joint 47° to 19°. (Fig 2)
No serious complications (tendon / ligament ruptures, nerve lesions or hypersensitivity
reactions) were observed after injections. In cases of group A (26 rays) that was treated
by partial fasciectomy, recurrence occurred in 6 rays and nerve injuries as nerve division
and neuropraxia occurred in 2 rays. (Table 2)
Figure 4: Lateral view show
improvement of flexion
deformity of left MCP joint of
little finger from 49° to 9°.
6. Table 2: Recorded Complication in both groups:
Open Fasciectomy (26 rays) Collagenase injection (7 rays)
Recurrence 6/26
Nerve division 1/26
Neuropraxia 1/26
Infection 0
Skin sloughing 0
Recurrence 1/7
Failure of treatment 1/7
Partial Stretch 1/7
Nerve injury 0
Hypersensitivity 0
Discussion
Our experience has shown that the use of injectable collagenase is an effective and well-
tolerated alternative to surgical treatment.
The patient must, however, be informed about the frequent occurrence of undesired side
effects (especially cost and hypersensitivity) as well as recurrence rate and
ineffectiveness of the treatment that may need surgical intervention.
As regard the undesirable side effects in group B, they were minimally and self-limiting
like swelling, bleeding, pain, redness in the puncture site. No nerve lesions were detected.
In elderly patients with multiple co-morbidities, who should avoid anesthesia or
postoperative wound healing problems, treatment with CCH is a very good alternative.
The effectiveness and patient satisfaction of collagenase treatment versus partial
fasciectomy are comparable; In view of the earlier return to work and surgical
complications, collagenase injection has the advantage.
However, the question of the significance in relation to partial fasciectomy cannot yet be
answered conclusively. The published recurrence rate shows considerable differences.
The method will have to be measured for the long-term recurrence rate and
complications.
Conclusion
The treatment of Dupuytren's disease with injectable collagenase has been proven safe
and effective, as confirmed by recent studies. However, the financial aspects should be
considered especially in developing countries.
Conflict of interest
There is no conflict of interest.
References
7. 1. Shaw Jr, R. B., Chong, A. K., Zhang, A., Hentz, V. R., Chang, J. Dupuytren’s disease: history,
diagnosis, and treatment. J Plastic reconstructive surgery 2007;120:44e-54e.
2. Townley, W., Baker, R., Sheppard, N., Grobbelaar, A. Dupuytren's contracture unfolded. J BMJ:
British Medical Journal 2006;332:397.
3. Watt, A. J., Curtin, C. M., Hentz, V. R. Collagenase injection as nonsurgical treatment of
Dupuytren's disease: 8-year follow-up. J The Journal of hand surgery 2010;35:534-539. e531.
4. Gelbard, M. K., James, K., Riach, P., Dorey, F. Collagenase versus placebo in the treatment of
Peyronie’s disease: a double-blind study. J The Journal of urology 1993;149:56-58.
5. Nydick, J. A., Olliff, B. W., Garcia, M. J., Hess, A. V., Stone, J. D. A comparison of percutaneous
needle fasciotomy and collagenase injection for Dupuytren disease. J The Journal of hand surgery
2013;38:2377-2380.
6. Peimer, C. A., Blazar, P., Coleman, S., Kaplan, F. T. D., Smith, T., Lindau, T. Dupuytren contracture
recurrence following treatment with collagenase clostridium histolyticum (CORDLESS [Collagenase Option
for Reduction of Dupuytren Long-Term Evaluation of Safety Study]): 5-year data. J The Journal of hand
surgery 2015;40:1597-1605.
7. Skirven, T. M., Bachoura, A., Jacoby, S. M., Culp, R. W., Osterman, A. L. The effect of a therapy
protocol for increasing correction of severely contracted proximal interphalangeal joints caused by
Dupuytren disease and treated with collagenase injection. J The Journal of hand surgery 2013;38:684-689.
8. Coleman, S., Gilpin, D., Kaplan, F. T. D., et al. Efficacy and safety of concurrent collagenase
clostridium histolyticum injections for multiple Dupuytren contractures. J The Journal of hand surgery
2014;39:57-64.
9. Hovius, S. E., Kan, H. J., Smit, X., Selles, R. W., Cardoso, E., Khouri, R. K. Extensive percutaneous
aponeurotomy and lipografting: a new treatment for Dupuytren disease. J Plastic reconstructive surgery
2011;128:221-228.
10. Van Rijssen, A. L., Ter Linden, H., Werker, P. M. Five-year results of a randomized clinical trial on
treatment in Dupuytren's disease: percutaneous needle fasciotomy versus limited fasciectomy. J Plastic
reconstructive surgery 2012;129:469-477.
11. Scherman, P., Jenmalm, P., Dahlin, L. One-year results of needle fasciotomy and collagenase
injection in treatment of Dupuytren’s contracture: A two-centre prospective randomized clinical trial. J
Journal of Hand Surgery 2016;41:577-582.
12. Desai, S. S., Hentz, V. R. Collagenase clostridium histolyticum for Dupuytren's contracture. J Expert
opinion on biological therapy 2010;10:1395-1404.
13. Warwick, D., Arner, M., Pajardi, G., et al. Collagenase Clostridium histolyticum in patients with
Dupuytren’s contracture: results from POINT X, an open-label study of clinical and patient-reported
outcomes. J Journal of Hand Surgery 2015;40:124-132.
14. Zhou, C., Hovius, S. E., Slijper, H. P., et al. Collagenase clostridium histolyticum versus limited
fasciectomy for Dupuytren’s contracture: outcomes from a multicenter propensity score matched study.
J Plastic reconstructive surgery 2015;136:87-97.
15. Starkweather, K. D., Lattuga, S., Hurst, L. C., et al. Collagenase in the treatment of Dupuytren's
disease: an in vitro study. J The Journal of hand surgery 1996;21:490-495.
16. Badalamente, M. A., Hurst, L. C., Hentz, V. R. Collagen as a clinical target: nonoperative treatment
of Dupuytren's disease. J The Journal of hand surgery 2002;27:788-798.
17. Peimer, C., Wilbrand, S., Gerber, R., Chapman, D., Szczypa, P. Safety and tolerability of collagenase
Clostridium histolyticum and fasciectomy for Dupuytren’s contracture. J Journal of Hand Surgery
2015;40:141-149.
8. 18. Chen, N. C., Shauver, M. J., Chung, K. C. Cost-effectiveness of open partial fasciectomy, needle
aponeurotomy, and collagenase injection for Dupuytren contracture. J The Journal of hand surgery
2011;36:1826-1834. e1832.
19. Atroshi, I., Strandberg, E., Lauritzson, A., Ahlgren, E., Waldén, M. Costs for collagenase injections
compared with fasciectomy in the treatment of Dupuytren's contracture: a retrospective cohort study. J
BMJ open 2014;4:e004166.
20. Cerveró, R. S., Ferrando, N. F., Jornet, J. P. Use of resources and costs associated with the
treatment of Dupuytren’s contracture at an orthopedics and traumatology surgery department in Denia
(Spain): collagenase clostridium hystolyticum versus subtotal fasciectomy. J BMC musculoskeletal
disorders 2013;14:293.
21. Peimer, C. A., Blazar, P., Coleman, S., et al. Dupuytren contracture recurrence following treatment
with collagenase clostridium histolyticum (CORDLESS study): 3-year data. J The Journal of hand surgery
2013;38:12-22.
22. Lipshultz, L. I., Goldstein, I., Seftel, A. D., et al. Clinical efficacy of collagenase Clostridium
histolyticum in the treatment of Peyronie's disease by subgroup: results from two large, double‐blind,
randomized, placebo‐controlled, phase III studies. 2015;116:650-656.
23. Povlsen, B., Povlsen, S. D. J. H. S. What is the better treatment for single digit dupuytren's
contracture: surgical release or collagenase clostridium histolyticum (Xiapex) injection? 2014;19:389-392.