Clinical outcome of patients with internal carotid artery occlusion: a prospective follow-up study

PURPOSE: We prospectively evaluated whether, and to what extent, different clinical presentations (symptomatic or asymptomatic) or the presence of atherosclerotic narrowing of the contralateral carotid system modifies the mortality rate and the incidence of nonfatal cerebrovascular events in patients with internal carotid artery (ICA) occlusion. METHODS: A prospective cohort study was conducted in the Unit Care of Angiology at the University Hospital of Padua in Italy. Consecutive patients with ICA occlusion were eligible for the study. Between 1990 and 1991, 41 such patients were identified at our center. All patients were observed prospectively for a mean of 44.5 months, except for one patient who was lost to follow-up after 12 months. Patients with severe (ie, more than 75%) stenosis of the contralateral internal carotid artery were scheduled for thromboendarterectomy. ICA occlusion was objectively documented in all patients by using a combination of echo-color Doppler scanning and continuous-wave Doppler scanning (periorbital flow). RESULTS: The overall mortality rate was 22.0% (95% CI, 10.6-37.6), and the stroke-related mortality rate was 7.3% (95% CI, 1.5-19.9). No differences in overall and stroke-related mortality rates were observed between asymptomatic and symptomatic patients. None of the patients experienced nonfatal cerebrovascular events. CONCLUSION: ICA occlusion seems to represent a relatively benign condition, in both its symptomatic and asymptomatic presentation. The presence of an atherosclerotic stenosis less than 75% of the contralateral ICA does not seem to worsen the prognosis of this condition.     

Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment

BACKGROUND: Idiopathic adhesive capsulitis is a commonly recognized but poorly understood cause of a painful and stiff shoulder. Although most orthopaedic literature supports treatment with physical therapy and stretching exercises, some studies have demonstrated late pain and functional deficits. The purpose of this study was to evaluate the outcome of patients with idiopathic adhesive capsulitis who were treated with a stretching-exercise program. METHODS: Seventy-five consecutive patients (seventy-seven shoulders) with phase-II idiopathic adhesive capsulitis were treated with use of a specific four-direction shoulder-stretching exercise program and evaluated prospectively. The initial evaluation included the recording of a detailed medical and orthopaedic history and assessment of pain, range of motion, and function. The outcome evaluation included assessment of pain, range of motion, and function; completion of the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire; and completion of the Short Form-36 (SF-36) Health Survey. The mean duration of follow-up was twenty-two months (range, twelve to forty-one months). One patient died prior to the final evaluation, and three patients were lost to follow-up. RESULTS: Sixty-four (90 percent) of the patients reported a satisfactory outcome. Seven (10 percent) were not satisfied with the outcome, and five (7 percent) underwent manipulation and/or arthroscopic capsular release. The outcomes of the patients who did not have manipulation or capsular release were evaluated. There were significant improvements in the scores for pain at rest (from a mean of 1.57 points before treatment to a mean of 1.16 points at the final evaluation; p < 0.001) and pain with activity (from a mean of 4.12 points before treatment to a mean of 1.33 points at the final evaluation; p < 0.0001). On the average, active forward elevation increased 43 degrees, active external rotation increased 25 degrees, passive internal rotation increased eight vertebral levels, and the glenohumeral rotation arc at 90 degrees of abduction increased 72 degrees (p < 0.00001). The number of "yes" responses to the Simple Shoulder Test increased from a mean of 4.1 (of a possible twelve) to a mean of 10.75 (p < 0.00001). Despite the significant improvements and the high rate of patient satisfaction, there were still significant differences in the pain and motion of the affected shoulder when compared with those of the unaffected, contralateral shoulder (p < 0.00001). At the final outcome evaluation, the DASH scores demonstrated limitations when compared with known population norms, whereas the profiles of the SF-36 were comparable with those of age and gender-matched control populations. Prior treatment with physical therapy and a Workers' Compensation claim or pending litigation were the only variables that were associated with the eventual need for manipulation or capsular release. Male gender and diabetes mellitus were associated with worse motion at the final evaluation. Patients with a greater severity of pain with activity at the initial evaluation had significantly lower DASH scores at the final evaluation, and patients with lower initial scores on the Simple Shoulder Test had comparatively lower scores on the Simple Shoulder Test at the outcome evaluation. CONCLUSIONS: The vast majority of patients who have phase-II idiopathic adhesive capsulitis can be successfully treated with a specific four-direction shoulder-stretching exercise program. Although measurable limitations and deficiencies were noted at the outcome evaluation, these appeared to be acceptable to most of the patients and did not affect their general health status. Patients with more severe pain and functional limitations before treatment had relatively worse outcomes. More aggressive treatment such as manipulation or capsular release was rarely necessary, and the efficacy of early use of these treatments should be further studied.     

Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study

BACKGROUND: The retear rate following rotator cuff repair is variable. Recent biomechanical studies have demonstrated that double-row tendon-to-bone fixation excels in initial fixation strength and footprint coverage compared with the single-row or transosseous fixation methods. This study was designed to report the repair integrity and clinical outcome following arthroscopic double-row rotator cuff repair. METHODS: A consecutive series of 106 patients with full-thickness rotator cuff tears underwent arthroscopic double-row rotator cuff repair with use of suture anchors and were followed prospectively. Twenty patients lacked complete follow-up data or were lost to follow-up. The eighty-six study subjects included fifty-two men and thirty-four women, with an average age of 60.5 years. There were twenty-six small, thirty medium, twenty-two large, and eight massive tears. Clinical outcomes were evaluated at an average of thirty-one months. Repair integrity was estimated with use of magnetic resonance imaging, which was performed, on the average, fourteen months postoperatively, and was classified into five categories, with type I indicating sufficient thickness with homogeneously low intensity; type II, sufficient thickness with partial high intensity; type III, insufficient thickness without discontinuity; type IV, the presence of a minor discontinuity; and type V, the presence of a major discontinuity. RESULTS: The average clinical outcome scores all improved significantly at the time of the final follow-up (p < 0.01). At a mean of fourteen months postoperatively, magnetic resonance imaging revealed that thirty-seven shoulders had a type-I repair; twenty-one, a type-II repair; thirteen, a type-III repair; eight, a type-IV repair; and seven, a type-V repair. The overall rate of retears (types IV and V) was 17%. The retear rate was 5% for small-to-medium tears, while it was 40% for large and massive tears. The shoulders with a type-V repair demonstrated significantly inferior functional outcome in terms of overall scores and strength compared with the other types of repairs (p < 0.01). CONCLUSIONS: Arthroscopic double-row repair can result in improved repair integrity compared with open or miniopen repair methods. However, the retear rate for shoulders with large and massive tears remains higher than that for smaller tears, and shoulders with large repair defects (type V) demonstrate significantly inferior functional outcomes.     

Quality of life after pelvic ring injuries: follow-up results of a prospective study

A follow-up after 2 years on average could be done in 43 cases of pelvic ring injuries. Seven were type A, 8 type B and 28 type C lesions. Every type A lesion was treated non-operatively. External fixation and nonoperative management were used with type B injuries. As well as non-operative treatment, both internal and external surgical techniques were employed for type C fractures. While group A hardly mentioned pain in the follow-up, groups B and C suffered dorsal pelvic pain of comparable intensity irrespective of the therapeutic measures taken. Anatomic reduction does not guarantee freedom from pain. We also rated hip joint flexibility and ability to walk according to the Merle D'Aubigné score. Because of their pelvic injuries 50% of the type C patients changed their profession. The sequelae of the accident on sports and leisure time activities will be considered as well as the subjective contentment evaluated. Unstable and dislocated pelvic ring injuries permanently interfere to a high degree with the quality of life. It is remarkable that many of the traumatic lesions which interfere with the quality of life are caused by the traumatic violence itself and cannot be influenced by the manner of surgical stabilization.     

Arthroscopic rotator cuff repair: prospective functional outcome and repair integrity at minimum 2-year follow-up

The purpose of this study was to assess arthroscopic repair of rotator cuff tears at a minimum of 2 years postoperatively with both patient-derived and objective outcome measures, including the use of magnetic resonance imaging (MRI), to evaluate repair status. Evaluated were 49 shoulders in 47 consecutive patients. The American Shoulder and Elbow Surgeons score, Constant and Murley score, Simple Shoulder Test, Rowe score, Visual Analog Pain Scale, and the Medical Outcomes Study Short Form-12 Mental Component Scale all improved significantly (P < .001) between the preoperative and final follow-up evaluations. MRI found 22% of repairs had recurrent tears. The presence of a recurrent tear correlated significantly with patient age (P < .009) and extension of the tear to the infraspinatus (P < .009). Active forward flexion, abduction, external rotation, and strength in forward flexion correlated inversely with the presence of a recurrent tear (P < .05). At minimum 2-year follow-up, arthroscopic repair of rotator cuff tears produced significant improvements in both patient-derived and objectively measured variables.     

Clinical and functional outcome of laparoscopic posterior rectopexy (Wells) for full-thickness rectal prolapse. A prospective study

Background Laparoscopic rectopexy offers the advantages of the open transabdominal approach while decreasing the surgical comorbidity. The aim of this prospective study was to assess the clinical and functional outcome of laparoscopic Wells procedure for full-thickness rectal prolapse. Methods Between 1999 and 2005, 77 patients underwent laparoscopic modified Wells procedure for full-thickness rectal prolapse. The patients were evaluated postoperatively for resolution of their prolapse and functional outcome, as well as for their satisfaction level regarding the procedure. Results Laparoscopy was successful in all but one case. There were no major intra- or postoperative complications and the mean hospital stay was 4.9 days. Approximately half of the patients had some degree of fecal incontinence preoperatively. At long-term follow up, 89 percent experienced alleviation of symptoms. Constipation was improved in 36% of cases. Eighteen percent of the patients suffered a new onset of constipation. Recurrent prolapse was observed in one patient. Ninety percent of the patients were satisfied at long-term follow-up. Conclusion The laparoscopic Wells procedure for rectal prolapse had good functional results, a low recurrence rate and proved to be a feasible and safe procedure. Postoperative constipation remains a problem, which should be solved.     

The COVID-19 pandemic and associated rise in pediatric firearm injuries: A multi-institutional study

BackgroundFirearm sales in the United States (U.S.) markedly increased during the COVID-19 pandemic. Our objective was to determine if firearm injuries in children were associated with stay-at-home orders (SHO) during the COVID-19 pandemic. We hypothesized there would be an increase in pediatric firearm injuries during SHO.MethodsThis was a multi institutional, retrospective study of institutional trauma registries. Patients <18 years with traumatic injuries meeting National Trauma Data Bank (NTDB) criteria were included. A “COVID” cohort, defined as time from initiation of state SHO through September 30, 2020 was compared to “Historical” controls from an averaged period of corresponding dates in 2016–2019. An interrupted time series analysis (ITSA) was utilized to evaluate the association of the U.S. declaration of a national state of emergency with pediatric firearm injuries.ResultsNine Level I pediatric trauma centers were included, contributing 48,111 pediatric trauma patients, of which 1,090 patients (2.3%) suffered firearm injuries. There was a significant increase in the proportion of firearm injuries in the COVID cohort (COVID 3.04% vs. Historical 1.83%; p < 0.001). There was an increased cumulative burden of firearm injuries in 2020 compared to a historical average. ITSA showed an 87% increase in the observed rate of firearm injuries above expected after the declaration of a nationwide emergency (p < 0.001).ConclusionThe proportion of firearm injuries affecting children increased during the COVID-19 pandemic. The pandemic was associated with an increase in pediatric firearm injuries above expected rates based on historical patterns.     

A prospective study comparing the functional outcome of computer-assisted and conventional total knee replacement

The aim of this prospective single-centre study was to assess the difference in clinical outcome between total knee replacement (TKR) using computerised navigation and that of conventional TKR. We hypothesised that navigation would give a better result at every stage within the first five years. A total of 195 patients (195 knees) with a mean age of 70.0?years (39 to 89) were allocated alternately into two treatment groups, which used either conventional instrumentation (group A, 97 knees) or a navigation system (group B, 98?knees). After five years, complete clinical scores were available for 121 patients (62%). A total of 18 patients were lost to follow-up. Compared with conventional surgery, navigated TKR resulted in a better mean Knee Society score (p = 0.008). The difference in mean Knee Society scores over time between the two groups was not constant (p = 0.006), which suggests that these groups differed in their response to surgery with time. No significant difference in the frequency of malalignment was seen between the two groups. In summary, computerised navigation resulted in a better functional outcome at five years than conventional techniques. Given the similarity in mechanical alignment between the two groups, rotational alignment may prove to be a better method of identifying differences in clinical outcome after navigated surgery.     

Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up

The aim was to study if postoperative rehabilitation improves functional outcome in lumbar spinal stenosis (LSS). Surgically treated LSS patients (n = 102) were randomized to rehabilitation-group (A) and “standard postoperative treatment”—group (B). Intervention for A-group started 3 months postoperatively, consisting of once a week outpatient visits for 12 weeks (1.5 h per visit; 1–6 patients per one physiotherapist). Physiotherapist guided stretching and strengthening exercises. A-group performed individually estimated exercises at those visits with guiding and at home up to 24-month postoperative follow-up. Physiotherapeutic guidance (12 times) was repeated after 12 months, in order to update exercises and motivate patients to keep training. For B-group, the “standard treatment” thus included normal postoperative treatment, or no treatment/self-management. Outcome measures were measured at the start and the end of the first physiotherapeutic intervention (3 and 6 months postoperatively), and at 12- and 24-month postoperative follow-ups. Oswestry Disability Index (ODI, 0–100%) was the main outcome measure. The other outcome measures were back- and leg pain separately (NRS-11); satisfaction (7-point scale) and treadmill test (0–1,000 m; not at 6 month). The intervention consisting of 12 + 12 physiotherapeutic sessions with further home exercises did not influence the course ODI in the 24-month postoperative follow-up (p = 0.95 for ODI; “as-rehabilitated” analysis). No influence on any other outcome measures was observed. After LSS surgery, routinely performed outpatient rehabilitation did not improve functional outcome compared to standard treatment. In addition, it had no impact on the back and leg pain, satisfaction and walking ability.     

Resurgence of methamphetamine related burns and injuries: A follow-up study

Purpose

Legislation enacted to curb methamphetamine production has only temporarily succeeded. Experiencing a recent increase in burns as a result of the new one-pot method, we compared methamphetamine related burn patients who utilized the previous anhydrous ammonia method of production to current patients who largely used the new one-pot method of production.

Basic procedures

Patients who were burned as a result of methamphetamine production were retrospectively reviewed. Comparisons were made including demographics, length of stay, injury severity score, hospital charges, total body surface area burned, inhalation injury, intubation, ventilator days, toxicology, fluid volumes, surgeries and complications.

Main findings

Eighteen current study patients (88.9% male) were compared to twenty-nine (86.2% male) previous study patients. The groups were similar in age, pattern of burn injury and intubation. Total body surface area burned, injury severity score, inhalation injuries, and ventilator days were not significantly increased in the current study. Longer length of stay and greater hospital charges were incurred by the current group. Burn surgeries per patient were significantly increased in the current group.

Principal conclusions

A new one-pot method has emerged despite legislative attempts to curtail methamphetamine production, and burns have also increased. The reason for more extensive burn surgeries in the current METH related burn patients remains enigmatic. Severity of injury and cost to society remain high.     

臂丛神经下干、内侧束部损伤133例的远期随访结果

目的观察臂丛神经下干、内侧束损伤患者术后的远期疗效。方法将133例臂丛下干、内侧束损伤患者分成神经断伤修复组40例,作神经端端缝合;神经断伤未修复组61例,未作处理;粘连松解组32例,行神经外松解术。术后随访2~14年,进行屈腕、屈指、分指并指检查及电生理检查。结果断伤未修复组无1例恢复功能。断伤修复组中8例的尺侧屈腕肌及指深屈肌肌力恢复至M3 ,但手内在肌功能未恢复。2例臂丛内侧束少部分神经断伤者在缝合神经的同时行神经松解,术后手内在肌肌力恢复至M3 。肌电图示肌肉强收缩时均为单纯-混合相。粘连松解组中75%(24/32)的手内在肌肌力恢复至M3 。结论(1)臂丛神经断裂不能直接修复者应作神经移位术。(2)神经直接修复者有31%恢复部分功能。(3)臂丛神经粘连松解者,有75%可恢复功能。     

Clinical evaluation and follow-up outcome of presurgical plan by Dextroscope: a prospective controlled study in patients with skull base tumors

Background

Patient-specific approach design, comprehensive evaluation on perioperative data, and follow-up of postoperative life quality (KPS) were carried out to evaluate the application of VR technology of Dextroscope in procedures of patients with skull base tumors.

Methods

Eighty-four patients with skull base tumors involved in this research were randomized into 2 groups (test group and control group), each with 42 patients. Before operation, image data such as MR, MRA, or CTA of head were collected and imported into the Dextroscope workstation. The detailed preoperative plans were made in the test group, but no Dextroscope plans in control group. The resection rate of tumors, preoperative evaluation including the duration of operation, total blood loss, the postoperative LOS, the number of cases with cerebrovascular injury complications in operation, and postoperative KPS of patients on discharge and the sixth month follow-up in the 2 groups were recorded and compared.

Results

The total resection rate of tumors was 83.33% in test group and 71.42% in the control group (P > .05). The total resection rate of meningioma was 86.67% in test group and 76.47% in control group. The total resection rates of trigeminal Schwannoma in the 2 groups were all 100% (P > .05). The duration of operation and the postoperative LOS of each patient were 5.25 ± 0.64 hours and 8.50 ± 1.10 days in the test group and 7.36 ± 0.87 hours and 12.50 ± 1.52 days in the control group, respectively (P < .05). Total blood loss of each patient was 456.75 ± 55.76 mL in the test group and 523.85 ± 66.78 mL in the control group (P > 05). There were 3 cases with complications of cerebral vessels injury in the test group and 7 cases in the control group (P < .05). During follow-up, KPS of patients in the test group on discharge (85.75 ± 9.68) was significantly superior to that in the control group (81.66 ± 9.24; P < .05). The KPS of patients on the sixth-month follow-up in the test group was 92.35 ± 9.95, which was significantly superior to that in the control group (85.6 ± 9.34; P < .05). Karnofsky performance scores of patients in the test group improved significantly from discharge to the sixth month after procedure (P < .05), whereas there were adverse results in the test group (P < .05). The 2 cases with CSF leakage were cured completely.

Conclusion

The preoperative plans with VR technology in patients with skull base tumor or CSF leakage operations can help certain the diagnosis, individually locate the position of skull base lesions, and design patient-specific approach, which also facilitate to shorten operation duration and the postoperative LOS, reduce total blood loss and injury of vessels in operation, and improve the postoperative KPS.     

A prospective study on acute spinal injuries

This work examines demographic and clinical characteristics of 163 consecutive cases of acute spinal injuries in a small area of Western Turkey, since 1982. These include all spinal injuries with or without neurological symptoms. Combined conservative and surgical methods were used for treatment. Age, sex, etiology, site of injury, radiologic findings, neurological status, and outcome are compared with the other studies. The results have been found to be parallel to those of the other studies except for some regional differences like an excess of tractor accidents.     

Cold hypersensitivity after hand injuries. A prospective 7-year follow-up

Abstract

We studied changes in cold hypersensitivity from 3 to 7 years following severe hand injuries. Data was collected using postal questionnaires 7 years after injury in 71 patients who had participated in a 3-year follow-up from the time of injury. There was no change in cold sensitivity measured using the McCabe Cold Sensitivity Severity scale (CSS) from 3 to 7 years after injury. However, there was a trend toward decreased severity measured using a five-level scale of self-reported cold hypersensitivity. Compared to the 3-year follow-up, fewer respondents rated their condition as severe and two patients had recovered from their cold hypersensitivity at the 7-year follow-up. Furthermore, 21 (30%) of the respondents stated a decrease in cold hypersensitivity during the last 2 years. Limitations in cold associated activities and the importance of being less limited in leisure activities (NRS 0-10) did not change between the two follow-ups. In conclusion, the CSS-scores did not change from 3 to 7 years after injury. Several patients experienced improvements in cold hypersensitivity, but few recovered completely from the condition.     

A prospective study of parachute injuries in civilians

A prospective study of 33 civilian parachutists with 41 injuries is presented. Because the training for civilians is less rigorous than that for military parachutists, the hospital admission rate for severe injuries was high (81.8%). Most injuries occurred during landing and the ankle was most frequently involved. The types and possible mechanisms of injury are discussed, as well as recommendations for modifying the civilian training programme.