Multiloculated pyogenic brain abscess: experience in 25 patients

OBJECTIVE: To report our experience in treating multiloculated pyogenic brain abscess and determine whether there are differences in the bacteriology, predisposing factors, treatment choices, and outcomes between multiloculated and uniloculated brain abscesses. METHODS: We studied clinical data collected during a 16-year period from 124 patients with pyogenic brain abscess, including 25 cases of multiloculated abscess. RESULTS: The incidence of multiloculated brain abscess was 20%. In these 25 patients, hematogenous spread from a remote infectious focus was the most common cause of infection, as it was for the cases of uniloculated abscess. Headache and hemiparesis were the most common symptoms in patients with multiloculated abscess. In patients with uniloculated abscess, fever was the most common symptom. Viridans streptococci were the most commonly isolated pathogens. Bacteroides fragilis was the most common anaerobe in multiloculated abscess, and aerobic gram-negative bacilli were the most common pathogens in patients with uniloculated abscess. Of the patients with multiloculated abscess, 21 were treated surgically and 4 were treated with antibiotics only. Overall, eight patients (38%) needed another operation because of abscess recurrence after the initial operation. In uniloculated abscess, the rate of abscess recurrence after initial surgery was 13.1%. Mortality was 16% in multiloculated abscess and 17.1% in uniloculated abscess. CONCLUSION: Multiloculated abscesses accounted for 20% of our patients with pyogenic brain abscess. Excision seems to be the more appropriate surgical choice in multiloculated abscess. Prognosis for patients with multiloculated abscess can be as good as that for patients with uniloculated abscess. However, clinicians must carefully monitor these patients because the possibility of recurrence after surgery is significantly higher in patients with multiloculated abscess than in those with uniloculated abscess.     

Microvascular hand surgery-transplants and replants-over the past 25 years

Two hundred eighty articles related to microvascular transplants and replants published in The Journal of Hand Surgery over the past 25 years were reviewed. Every facet of microsurgery was covered. One hundred seventy-one articles are referenced and discussed under the following major categories: microvascular transplants, replants, nerve grafts, vein grafts, cold intolerance, vasospasm, monitoring, immediate reconstruction, and historical. Contributions were received from 37 countries and 175 authors or groups of authors.     

Survival of 25 osteoarticular allografts followed more than 10 years

An evaluation of the long-term survival rate of 25 osteoarticular allografts was made. Clinical analysis was based on the Mankin scale and the Musculoskeletal Tumor Society (MSTS) Grading system. After a mean follow-up time of 15 years 76% of the osteoarticular allografts had good or excellent rating. The MSTS scale revealed a mean score of 89% for those 20 grafts still functioning according to their primary purpose. Allograft related complications occurred in 32% of the cases being most common among malignant cases. Due to the rather good long-term results, osteoarticular allografts can still be recommended for hemicondylar allograft reconstruction in benign lesions.     

The top 100 cited of injury-international journal of the care of the injured: A bibliometric analysis

BackgroundWith nearly 50 years’ of development, Injury has become one of the leading journals in its specialty. The aim of this article is to identify, analyze the characteristics of the 100 most cited articles published by the journal to date.MethodWe searched the Thomson Reuters Web of Science Core Collection for citations of all articles published in Injury since its launch. For the Top 100 most frequently cited articles, title, author name, number of authors, publishing date, citation number, country of origin, institution, pages, number of reference, type of article, study topic, study design, funding source, and level of evidence of each clinical article were recorded and analyzed.ResultsOnly 50 self-citations were found in 12436 total citations of the top100 articles, fifty-four articles exceeded 100 citations. Total citations of the Top 100 articles ranged from 77 to 599. The Top 100 articles were published between 1973 and 2012, the mean authorship and institution number per paper was 3.92 and 1.84 respectively. The mean page number was 8.26 and the mean reference number was 45.2. England, Germany and Switzerland ranked the top three countries of origin. Among the T100 articles, there were 50 clinical studies, 5 basic researches, and 45 reviews. The most common study type was case series, and most common topics were bone reconstruction, trauma and bone fracture. The most common level of evidence was level Ⅳ.ConclusionsThis study may help researchers to find out the important information on the classic articles and provides useful insights for the authors who want to publish their research in Injury.     

Primary carcinoma of the gallbladder: review of 25 cases.

The records of 25 patients with carcinoma of the gallbladder occurring during a 5 year period were reviewed. The frequent relation of the disease with cholelithiasis and benign tumors has been widely recognized. Stones were present in the gallbladder in 92 per cent of the patients. In the majority of cases, a diagnosis of carcinoma of the gallbladder was not made clinically. The most common preoperative diagnosis was benign biliary tract disease. The mean survival time after operation was 7 months, and only five patients had a curative resection. The best hope for reducing the mortality from this disease lies in earlier cholecystectomy in patients with benign gallbladder disease.     

Relationship between serum 25-hydroxyvitamin D and bone resorption markers in vitamin D insufficiency

It is known that nursing-home patients with vitamin D insufficiency have elevated serum parathyroid hormone (PTH) as well as raised serum alkaline phosphatase (ALP). Although it is well known that vitamin D insufficiency and secondary hyperparathyroidism are common among the elderly in western countries, there is continuing controversy over the level of serum 25-hydroxyvitamin D [25(OH)D] necessary for bone health. We approached this issue by examining the relationships between serum 25(OH)D, ionized calcium, PTH, and ALP and the urinary bone resorption markers hydroxyproline, pyridinoline, and deoxypyridinoline, corrected for creatinine (OHPr/Cr, Pyd/Cr, and Dpd/Cr, respectively), in 486 postmenopausal women of mean age 63 (SD 9.5) years, who were referred to our osteoporosis and menopause clinics for investigation. When the patients were divided into two groups with 25(OH)D above and below 20 nmol/L, 30 nmol/L, 40 nmol/L, 50 nmol/L, 60 nmol/L, or 70 nmol/L, the most significant differences between the two groups thus derived was found at a serum 25(OH)D level of 60 nmol/L (P < 0.001 for all markers). The most significant difference between groups for serum PTH was found when the patients were divided at a serum 25(OH)D of 50 nmol/L. PTH, OHPr/Cr, Pyd/Cr, and ALP were inversely related to serum 25(OH)D. PTH was inversely related to serum ionized calcium. There was a trend for ionized calcium to be positively related to 25(OH)D, but this did not reach statistical significance. We conclude that rises in three bone resorption markers and ALP can be detected in postmenopausal women when the serum 25(OH)D level falls below 60 nmol/L. Levels above this may be required for optimal bone health.     

Bibliometric analysis of the top 50 most cited publications of the Journal of Clinical Orthopaedics and Trauma

BackgroundThe Journal of Clinical Orthopaedics and Trauma (JCOT) is one of the top three orthopaedic journals from India. We set out to analyse the top 50 cited articles from JCOT since indexing in PubMed and Scopus.MethodsWe looked into the bibliometrics of the top 50 cited articles and compared citations from PubMed and Scopus, and depicted outputs from VOS viewer analysis on co-authorship and keywords.ResultsTotal citations for top-cited articles were 1076 in numbers, with a maximum of 103.2016 and 2018 were the most productive years. The major contribution was from India with 74%, followed by the USA. New Delhi published maximally at 72%. Clinical topics and narrative reviews were the most common types of studies. Trauma and Adult reconstruction was the most common sub-specialities, and Level 4 was the most frequent level of study. The basic science and COVID-19 related articles received the maximum citations. The authors from Indraprastha Apollo Hospitals published the maximum number of top-50 cited articles in the JCOT.ConclusionsThere is a steady increase in the number of publications in the JCOT, with an increasing number of citation counts. Both the Indian and foreign authors have been publishing in this journal at a comparative rate. Although the citation counts in Scopus are more than those in PubMed for given articles, more than 80% of articles are listed in both databases as top 50 cited articles. The majority of top-cited articles belonged to trauma and adult reconstruction, level III studies, and narrative reviews.     

Is lateral ankle sprain of the child and adolescent a myth or a reality? A systematic review of the literature

BackgroundAnkle trauma in children and adolescents is the most common orthopedic injury encountered in pediatric trauma. It has long been recognized that a lateral ankle injury in this population is often a Salter and Harris type I fracture of the distal fibula (SH1). The purpose of this study is to confirm the existence of a lateral ankle sprain and to report the incidence of each pathology of the lateral ankle compartment: SH1 fracture, ATFL injury, and osteochondral avulsions.MethodsA systematic review of the literature is done using the database provided by PubMed and Embase. All articles reporting the incidence of imaging modality-confirmed lateral ankle injury (SH1, ATFL injury, osteochondral avulsion) in children and adolescents were included. Exclusion criteria were the following: case reports or articles with less than ten subjects, unspecified imaging modality and articles unrelated to lateral ankle lesions. Thus, 237 titles and abstracts were selected, 25 were analyzed thoroughly, and 11 articles were included for final analysis.ResultsSH1 fractures were found in 0–57.5% of the cases in all series and 0–3% in the most recent series. A diagnosis of an ATFL injury was found in 3.2–80% and an osteochondral avulsion of the distal fibula in 6–28.1%. The most recent series report 76–80% and 62% for ATFL injury and osteochondral avulsion respectively.ConclusionsThere is a non-negligible incidence of ATFL sprains and fibular tip avulsions in patients with a suspected SH1 fracture of the distal fibula. According to recent evidence and MRI examinations, the most common injuries of the pediatric ankle are ATFL sprain and osteochondral avulsions. This should be taken into consideration in daily practice when ordering radiological examination and deciding on treatment modalities     

Male genital lymphedema: clinical features and management in 25 pediatric patients

PurposeGenital lymphedema in the pediatric population is poorly understood. The purpose of this study was to determine the epidemiology, morbidity, and treatment outcomes for males with genital lymphedema.Materials and methodsMale patients with genital lymphedema evaluated at our vascular anomalies center between 1995 and 2011 were reviewed. Etiology, age-of-onset, location, morbidity, and treatment were analyzed.ResultsOf the 3889 patients with vascular anomalies, 25 (0.6%) had genital lymphedema: 92% (23/25) with primary and 24.0% (6/25) with familial/syndromic lymphedema. For primary disease, the mean age-of-onset was 4.5 ± 6.3 years with 60.9% (14/23) presenting in infancy, 13.0% (3/23) in childhood, and 26.1% (6/23) in adolescence. Combined penoscrotal lymphedema was identified in 72.0% (18/25) of patients; 19 children (76.0%) had concomitant lower extremity involvement. The most common complication was cellulitis (24.0%). Surgical contouring was performed in 44.0% (11/25) of patients. Patients with operative intervention and follow-up (n = 6) had sustained improvement after a median of 4.2 years (range: 0.3–11.0).ConclusionsLymphedema of the male genitalia is typically idiopathic. Most patients develop swelling in infancy but can present in adolescence and occasionally childhood. The penis and scrotum are usually both involved and concurrent lower-extremity swelling is common. Surgical debulking can improve symptoms and appearance.     

Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass is the most common bariatric procedure performed in the United States today. The most common early complication after laparoscopic Roux-en-Y is stenosis. No randomized studies have compared the effect of the different staplers on the incidence of stenosis or on long-term weight loss. We compared the anastomoses performed with the two sizes of circular stapler in common use. METHODS: A total of 200 patients were randomized to undergo 21-mm (n = 100) or 25-mm (n = 100) circular stapled gastroenterostomy after induction of anesthesia. No other differences were allowed in the operative technique. Stenosis was defined as patient complaints of dysphagia leading to endoscopy within 10 weeks of surgery, in which a 9-mm diameter endoscope would not pass through the gastroenterostomy without dilation. RESULTS: Of the 200 patients, 19 patients in the 21-mm group and 8 in the 25-mm group underwent endoscopy for symptoms (P = 0.027). Of the 19 and 8 patients, 17 and 7, respectively, had measurable stenosis at endoscopy (p = 0.035). Patients with a 21-mm anastomosis developed symptoms an average of 4.8 +/- 1.2 weeks after surgery, and those with a 25-mm anastomosis developed symptoms an average of 8.9 +/- 3.8 weeks postoperatively (P <0.001). CONCLUSIONS: We found a significant difference in the stenosis rate between the 21-mm and 25-mm circular stapled anastomoses in laparoscopic Roux-en-Y gastric bypass. The 21-mm staplers led to significantly more endoscopies than did the 25-mm staplers. Symptoms leading to endoscopy occurred significantly later with use of a 25-mm stapler than after a 21-mm stapler.     

Top 20 cited Spine Journal articles, 1990-2009

AIM: To determine the most cited articles and most published authors in Spine Journal from 1990-2009.METHODS: Spine Journal, established in 1976, is affiliated with 12 spine societies and a leader in spine research articles. Citation analysis is a method to determine the impact of a journal and its articles on academia and clinical practice. Using the Institute for Scientific Information Web of Knowledge, we determined the most cited articles in Spine Journal between1990-2009. The characteristics and type of article were recorded. Next, we evaluated the most published authors during the same time period and calculated the number of citations for each author. The number of first authorships for each of these authors was also determined along with the number of citations for those articles.RESULTS: The top 20 cited articles range from 491 to 267 total citations. The top 20 published authors had between 41 and 135 articles. Seventeen of the top 20 articles were clinical studies. The range of citations per lead authorship ratio was 36 to 724 with one author having no lead authorships. Low back pain was the most common theme encountered in the top cited articles. The first-ranked article was not a spine-specific topic rather it was regarding general physical and mental health status survey update review.CONCLUSION: Spine Journal and its authors have a clear impact on the scientific community based on this review of the top articles and authors in the last 20 years.     

A Global Bibliometric Analysis of Hallux Valgus Research (1999-2019)

Hallux valgus (HV) is a very common deformity among foot disorders, therefore attracting strong interest from foot and ankle surgeons. We investigated publication trends on HV in the literature. The analysis was conducted through an electronic search of the Web of Science database for publications between 1999 and 2019, studying the data of origin through bibliometrics. The following search string was utilized: TI = (hallux valgus* OR hallux abductovalgus*) with filters for the English language and documents in article format. The “Bibliometrix” package of R software was used for the bibliometric analysis, and the VOSviewer was used to create graphs. A total of 789 articles were found in the electronic search, with 2,723 cited articles. The most common Web of Science category was Orthopedics (83.0%), and Coughlin M.J. was the main researcher in this field with the largest number of publications (17). The United States led in terms of the number of published articles (26.7%). An increase in the number of publications over time was noted, with 2016 being the year with the highest number of articles (78). The journal with the most articles was Foot and Ankle International, with 35.2% of the publications. The number of published studies on HV has increased rapidly since 2012. The United States ranks first in related research worldwide. The journal with the most articles was Foot and Ankle International.     

Laparoscopic assisted vaginal hysterectomy (LAVH). Overview on 25 case series

The aim of the study is to evaluate the laparoscopically assisted vaginal hysterectomy (LAVH) in terms of indications, uterine size, surgical procedures and their safety, intraoperative complications and blood loss, operative time, concomitant surgical procedures and postoperative period of complications. A total of 25 patients underwent LAVH between 1998 and 1993, in our surgical unit. The mean age of our patients was 44.2 years (range 36-66). The most common indication was fibromyoma. The mean size of the removed uterus was 11.5 cm. The mean weight was about 242 g. The mean estimated blood loss was 155 ml and the mean operative time 150 min. Intraoperative complications included one case of bladder injury due to thick adhesions. Postoperative complications included 2 cases of cystitis, and 3 cases of ileus. The hospital stay was 2 to 7 days.     

Duplicate publication in the field of otolaryngology-head and neck surgery.

OBJECTIVE: This study establishes the approximate prevalence and patterns of duplicate publication in the medical literature in the specialty of otolaryngology-head and neck surgery. STUDY DESIGN AND SETTING: All of the authors and articles published in the American Medical Association Archives of Otolaryngology-Head and Neck Surgery were identified and listed for an 8-year period. During this time, 1965 authors published 1082 articles in the Archives, and this same set of authors published a total of almost 50,000 articles during the 12-year period between January 1977 and December 1988. Of the same set of 1965 authors, we picked 1000 at random and found that they had published a total of 24,353 articles. The titles of these articles were then screened for similar titles, and when similarities were noted, the complete articles were obtained when possible and compared for the degree and pattern of duplicate publication. RESULTS: Of the 1000 authors studied, we found that 228 authors had published 938 articles with similar titles. We were able to obtain the full copy of 886 (94%) of the 938 articles in question, which were written by 226 (99%) of the 228 authors. We found that in the case of 25 authors, there was no duplication despite the similar titles, but in the case of 201 (20% of the 1000) authors, 644 articles were published with some degree of duplication (1.8% duplication rate). CONCLUSIONS: The most common duplicate publication involves sequential publication of very similar data and conclusions. Duplicate publications failed to reference prior articles by the same author 32% of the time or referenced the prior articles only partially (11% of the time). Artificial segmentation of a single study into multiple arbitrary segments composed 20% of the duplicate publication. Duplicate publication across different specialties was noted to account for 4% of the instances. Most of the authors duplicated only once or twice, and most duplicators do reference their prior publications. SIGNIFICANCE: Duplicate publication is an example of inappropriate academic conduct. Because it tarnishes the reputation of the duplicating author and represents an unfair practice in terms of displacing the work of others, efforts should continue to educate authors, particularly young academicians, to avoid the practice of duplicate publication.     

The external fixation test of the lumbar spine: 30 complications in 25 of 100 consecutive patients

We retrospectively analyzed the rate and character of complications in a series of 100 consecutive external fixation tests during 1985-1991. There were 30 complications in 25 patients. The most common was pin tract infection, which was definite in 12 cases and probable in 6. Altogether 12 patients developed complications that resulted in removal or reapplication of the device. 8 cases had an incorrect position of a Schanz screw; 3 of these had neurological complications. The only variable having a significant association with complications was the duration of the test. Because of this complication rate, the indications for the test should be carefully considered.     

Trends in rotator cuff surgery: Research through the decades

IntroductionThe aim of this study is to analyse the most cited articles in rotator cuff surgery and identify trends in topics by decade to see which areas may still need further investigationMethodsJournal Citation Index was searched to find articles using the search terms pertaining to “rotator cuff repair”. All articles were ranked according to most cited, and then further analysed to find most cited articles in each decade. Articles were grouped into topics to find themes for each decade.ResultsAll the most cited articles were published in 6 orthopaedic journals. Only 4 of the top 30 citations provided level I evidence. Each decade’s most cited articles seemed to fit into a broad topic, with platelet-rich plasma and biologic augmentation being prominent in the last decade.ConclusionThere are still many unanswered questions in rotator cuff surgery, but this may be because success of certain treatment options are highly dependent on patient selection. Despite growing numbers of articles being published on rotator cuff repairs, the level of evidence remains low. Larger, collaborative projects may help in answering the common dilemmas that still face shoulder surgeons.     

A New Suture for Hair Transplantation: Poliglecaprone 25

BACKGROUND: The most common type of donor closure in hair transplantation is with nonabsorbable, running sutures, usually of nylon or polypropylene. This is accomplished with or without buried absorbable sutures. Another popular method of closure is with stainless steel staples. Each of these methods has benefits and limitations with respect to healing, comfort, and convenience for the patient. OBJECTIVE: The purpose of this study is to describe the use of poliglecaprone 25, a synthetic, absorbable, monofilament suture in hair transplantation surgery, to detail the suturing techniques needed to maximize the benefit of this suture, and to compare this material and suturing technique to a well-established form of closure, that of metal staples in a bilaterally controlled fashion. METHODS: Poliglecaprone 25 is a synthetic, absorbable monofilament suture of low tissue reactivity. It was compared to closure with metal staples in a bilateral controlled study. One side of the donor area was closed with poliglecaprone 25 sutures using a running cutaneous stitch and the other side was closed with stainless steel staples. Patients were evaluated with regard to healing, postoperative discomfort, resultant surgical scar, and closure material preference. RESULTS: Of the 22 patients studied, the following postoperative complaints were noted on the staples side: tenderness (12), itching (4), swelling (2), and scabbing (1). This compared to only one complaint of itching and one complaint of swelling on the poliglecaprone 25 side. Two patients had postoperative complaints of visibility of staples showing through their hair. Objective measurements revealed a wider scar overall on the staples side in six patients and wider scar on the suture side in two patients. The average scar width on the staples side measured 1.78 mm compared to 1.42 mm on the suture side. Fourteen of the 22 patients preferred poliglecaprone 25 for future procedures, 1 preferred metal staples, and 7 had no preference. Most patients stated that postoperative discomfort from the staples and the inconvenience and occasional pain associated with their removal was responsible for their decision. CONCLUSION: Poliglecaprone 25 is a strong synthetic, absorbable, monofilament suture with low tissue reactivity that can be used in hair transplantation to close the donor wound with a single, running cutaneous stitch. This suture can provide a donor closure that ensures hemostasis, has little risk of infection, and is comfortable for the patient. If specific surgical techniques are followed, this suture can provide a donor closure that ensures hemostasis has little risk of complications, is both comfortable and convenient for the patient postoperatively and results in a fine surgical scar.     

Stigmatization of Repetitive Hand Use in Newspaper Reports of Hand Illness

Failure to provide a balanced evidence-based consideration of the role of activity in illness can stigmatize individuals and their activities. We assessed the prevalence of language that stigmatized repetitive hand use and those that use their hand repetitively in newspaper coverage of common hand illnesses. The LexisNexis Academic database was used to search five major US newspapers for articles containing keywords about common hand illnesses during a 3-year period. Article language was assessed for stigmatization of activities involving repetitive hand use as well as for stigmatization of patients who use their hand repetitively. One hundred and twenty-four articles on hand illnesses were identified. Of these, 65.3% of articles stigmatized activities involving repetitive hand use, including 96.6% of articles discussing overuse injury of the hand, 90% of articles discussing tendonitis or tenosynovitis, and 51.8% of articles discussing carpal tunnel syndrome. Patient stigmatization was documented in 30.6% of the newspaper articles. Stigmatizing statements were most commonly made by journalists (94.8%), followed by patients (3.1%), and physicians (2.1%). Language that stigmatizes repetitive hand use and patients who use their hand repetitively is prevalent among US newspaper articles. Both health professionals and journalists reporting health-related news should be more sensitive to the use of stigmatizing language and provide a more balanced, measured, and evidenced-based account of hand illnesses.