Effectiveness of anabolic steroids in improving outcomes for post-operative hip fracture patients: A randomized controlled trial

BackgroundPost-operative elderly hip fracture patients require significant rehabilitation. Nandrolone is an anabolic steroid used to promote muscle growth. This study aims to examine the effect of nandrolone in improving rehabilitation and quality of life in elderly female patients with hip fractures undergoing hemiarthroplasty.MethodsThis is a double-blinded prospective randomized-controlled-trial consisting of female patients above the age of 65 with an isolated neck of femur fracture planned for a hip hemiarthroplasty. Participants were randomized into two arms of the study – 50 mg intramuscular nandrolone vs normal saline placebo administered on post-operative day 0, and weeks 2, 6 and 12. The participants were followed up across a 1-year period following the surgery. Clinical outcomes such as time taken to achieve rehabilitation milestones, distance of ambulation and thigh muscle girth, and functional scoring with SF-36 questionnaire were recorded at intervals of 2, 6 and 12 weeks, 6 months and 1 year following the surgery.ResultsThere were a total of 23 subjects with 11 in the steroid group and 12 in the placebo group. There was no significant difference in demographics and injury patterns between both groups. There was no significant difference for time taken to achieve various rehabilitation milestones and distance of ambulation. SF-36 scores on discharge and at 1-year follow-up mark were comparable. There was no difference in the complication rate between both groups.ConclusionIntra-muscular Nandrolone after hip surgery in elderly female patients does not result in short to mid-term improved rehabilitation or functional outcomes. Nandrolone did not result in increased short-term complications after hip surgery.Level of evidenceI.     

Incidence and risk factors for Chyle leak after pancreatic surgery for cancer: A comprehensive systematic review

BackgroundChyle leak (CL) is a clinically relevant complication after pancreatectomy. Its incidence and the associated risk factors are ill defined, and various treatments options have been described. There is no consensus, however, regarding optimal management. The present study aims to systematically review the literature on CL after pancreatectomy.MethodsA systematic review from PubMed, Scopus and Embase database was performed. Studies using a clear definition for CL and published from January 2000 to January 2021 were included. The PRISMA guidelines were followed during all stages of this systematic review. The MINORS score was used to assess methodological quality.ResultsLiterature search found 361 reports, 99 of which were duplicates. The titles and abstracts of 262 articles were finally screened. The references from the remaining 181 articles were manually assessed. After the exclusions, 43 articles were thoroughly assessed. A total of 23 articles were ultimately included for this review. The number of patients varied from 54 to 3532. Incidence of post pancreatectomy CL varied from 1.3% to 22.1%. Main risk factors were the extent of the surgery and early oral or enteral feeding. CL dried up spontaneously or after conservative management within 14 days in 53% to 100% of the cases.ConclusionsThe extent of surgery is the most common predictor of risk of CL. Conservative treatment has been shown to be effective in most cases and can be considered the treatment of choice. We propose a management algorithm based on the current available evidence.     

Post-operative management after total ankle arthroplasty: A systematic review of the literature

BackgroundCurrently, there is no consensus on the most appropriate post-operative management for patients undergoing total ankle arthroplasty. The aim of this study is therefore to offer a systematic review of the pertaining literature to identify current post-operative protocols and describe possible differences.MethodsA systematic review to identify recent studies concerning the post-operative management after total ankle arthroplasty was conducted. Five topics were analyzed: length of hospital stay, type and duration of immobilization, weight-bearing management, post-operative pharmacological therapies, adopted rehabilitation scheme.ResultsEighty-four studies met the inclusion criteria and were included in the review process. Most of the papers appear to have conflicting opinions with no consensus and homogeneous protocols.ConclusionDue to various methodological limitations, it is not possible to provide sufficiently supported evidence-based recommendations, and it is therefore difficult to determine the superiority of one post-operative protocol over the others after total ankle arthroplasty.     

经皮球囊扩张椎体成形术手术并发症的观察护理

目的：探讨经皮球囊扩张椎体成形术（PKP）治疗胸腰椎压缩性骨折术后并发症的观察护理。方法对30例（34个椎体）接受PK P手术治疗的胸腰椎压缩性骨折的患者进行心血管反应、肺栓塞、骨水泥外渗、神经损伤等并发症的观察与护理，发现异常及时处理。结果本组患者中，1例出现心血管反应，2例出现骨水泥漏，2例疼痛缓解不明显，经6～12个月随访复查，胸腰椎X线片未发现椎体有形态学改变及椎体新压缩出现，也未发生全身性并发症。结论术后及时有效进行并发症观察及护理，是提高手术成功率、减少或避免并发症发生的保证。     

临床护理路径对乳腺癌术后患者生活质量与自护能力影响的分析

目的分析应用临床护理路径对乳腺癌术后患者生活质量与自护能力的影响。方法选择180例乳腺癌术后患者，依据随机原则分为对照组90例，予以常规护理模式；研究组90例，依据临床护理路径予以护理措施。应用多种生活质量量表，包括：SF-36量表、QLQ-B2R3量表评估两组患者的生活质量；应用自我护理能力测量量表（ESCA），评估两组患者的自护能力；应用家庭关怀度指数测评量表（APGAR），调查评估两组患者的家庭支持状况。结果与对照组相比，研究组的SF-36量表与QLQ-B2R3量表评分总分及各维度得分、ESCA量表评分总分及各维度得分、APGAR量表调查总分及各维度得分与对照组相比差异有显著意义（P〈0．05）。结论应用临床护理路径，能显著改善乳腺癌术后患者生活质量与自护能力。     

安全型无指硬底约束手套在防止患者术后拔管中的应用

目的：探讨安全型无指硬底约束手套对术后患者的约束效果。方法采用随机抽样的方法，将100例术后患者随机分为观察组（50例）和对照组（50例），分别应用安全型无指硬底约束手套及常用约束带对患者进行防护性约束。结果观察组患者拔管及并发症的发生率显著低于对照组（ P＜0．05、P＜0．01）。结论安全型无指硬底约束手套的防护性约束效果明显优于目前常用的约束带。     

A novel approach using liquid embolic agent for the treatment of pancreatic-cutaneous fistulas: Report of a case

Pancreatic fistula formation remains one of the most dreadful complications after pancreaticoduodenectomies, resulting in extended hospital stays, increased healthcare costs, along with significantly increased morbidity and mortality. Little is mentioned in the literature about the use of percutaneous techniques to resolve this complication when conservative treatments fail. Thus, we developed a novel technique for treating pancreatic-cutaneous fistulas that develop post-pancreaticoduodenectomy. This work describes a novel approach of using a liquid embolic agent to treat a high-output pancreatic-cutaneous fistula after a Whipple procedure, which to the best of our knowledge after extensive literature searches, has not been performed before.