Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65–94?years

Background

Chronic subdural haematoma (cSDH) is a common disease in neurosurgical practise, especially in elderly patients. This is of growing importance as the number of elderly people in the population is increasing steadily. There are scarce data focussing especially on elderly patients with cSDH. This study intended to evaluate the outcome and peri-operative risks in elderly patients with cSDH.

Methods

We retrospectively reviewed medical records of 322 consecutive patients aged ≥65?years treated at our department between 2002 and 2009 focussing on outcome, aetiology, peri-operative risks, recurrence rate, and co-factors such as concomitant diseases and therapy with anticoagulants. The surgical procedure included burr-hole craniostomy followed by insertion of a subdural drain in each case. The outcome was classified according to the Karnofsky performance status (KPS) and modified Rankin Scale (mRS) score. Patients were divided into three groups according to age (group I: age 65–74?years, group II: 75–84?years, group III: 85–94?years).

Results

Three hundred twenty-two patients underwent burr-hole craniostomy for cSDH in 399 surgical procedures. The mean age was 76?±?7.9?years. After surgery, the mean neurological status improved in all three groups. Overall favourable outcome (mRS 0–2) was achieved in 83?% in group I, 68?% in group II and 51?% in group III, respectively. The rate of recurrence was lower in group III (7.5?%) compared to groups I (21.5?%) and II (27.37?%, p?=?0.004). Overall, complication rates and peri-operative mortality (2.75?%) did not differ significantly between the age groups.

Conclusion

The data of the current study suggest that treatment of cSDH is safe in elderly patients. Patients aged above 85?years carry a greater risk for peri-operative complications, i.e. aSDH, and therefore have to be examined and monitored meticulously in order to prevent complications.     

Band erosion after laparoscopic gastric banding: a retrospective analysis of 865 patients over 5 years

Background  

Gastric band erosion is a well-reported complication after laparoscopic adjustable gastric banding (LAGB). The published literature is limited and inconclusive with regard to its management. The authors therefore reviewed all band erosions detected during a 5-year period in a high-volume bariatric practice. Because a significant proportion of the band insertions (65%) were undertaken by an operator beyond his learning curve, the authors hoped to gain a mature, comprehensive understanding of this significant complication.     

Minimally invasive repair of pectus carinatum: a retrospective analysis based on a single surgeon’s 10 years of experience

Objectives

Over the past decade, minimal invasive surgery for correction of pectus carinatum has gained worldwide acceptance. This study reviews our clinical experience with minimally invasive repair of pectus carinatum (MIRPC) since 2008.

Methods

Between 2008 and 2018, 101 patients (77 male, 24 female) underwent correction of pectus carinatum with the MIRPC technique. The mean age of the patients was 14.7?±?4.8 (3–38) years. Over an 8 years’ experience we slightly modified the original Abramson technique. All patients presented with cosmetic complaints and all had a flexible chest wall on “compression test”. Early follow-up was on postoperative day 15 and 30.

Results

The mean operative time was 42.1?±?16.9 min. The mean hospital stay was 4.2?±?0.9 days. Postoperative complications included pneumothorax (n?=?2, 1.9%), wound infection (n?=?2, 1.9%), skin perforation (n?=?2, 1.9%), intolerable pain (n?=?1, 0.9%), skin hyperpigmentation (n?=?1, 0.9%), and overcorrection (n?=?1, 0.9%). Initial postoperative results were excellent in all patients. The bars were removed at a median of 24.8?±?4.5 months in 44 of 101 patients. 43 of 44 (97.7%) patients whose bar were removed reported excellent results.

Conclusions

MIRPC is a feasible procedure with low morbidity and excellent cosmetic results in the treatment of pectus carinatum deformities in selected patients.

     

The first successful heart–lung transplantation in Japan: report of a case

Although legislation regarding organ transplantation from brain-dead donors in Japan was approved in 1997, no heart–lung transplantation procedures were performed for some time. Herein, we report the first case of successful heart–lung transplantation in Japan. The recipient was a 35-year-old man with Eisenmenger syndrome, caused by a double outlet right ventricle, who had been suffering hemoptysis and continued NYHA class 3–4 symptoms for 66 months since being registered on the waiting list. He underwent heart–lung transplantation from a 30-year-old donor. The organ ischemic time was 247 min, the postoperative course was uneventful, and the patient was discharged 66 days after the transplant surgery.     

Morselized bone grafting in revision arthroplasty of the knee: A retrospective analysis of 34 reconstructions after 2–9 years

Background and purpose?Loosening of a total knee replacement may lead to loss of bone, requiring biological reconstruction at revision arthroplasty. Good results have been reported from revision arthroplasty of the hip using impaction bone grafting. We report our results of revision total knee arthroplasty using the same technique.

Patients and methods?We retrospectively analyzed 30 patients (involving 34 knees) with a mean age of 63 (34–81) years who, between 1994 and 2002, underwent revision arthroplasty of the knee using hinge or rotational knee prostheses (Link) and impaction bone grafting. The average follow-up was 4 (2–9) years and included a questionnaire, a clinical examination, and standardized radiographs.

Results?25 patients were satisfied with their results. 10 patients reported no impairment in their activities of daily living attributed to their operation and did not need any walking support. In 5 patients, there were no clear radiographic signs of incorporation of the graft but that did not compromise the outcome. 5 other patients had complications due to aseptic loosening of their prostheses with radiographic failure of the graft, leading to a periprosthetic fracture in 2 cases.

Interpretation?Our results with impaction bone grafting in knee revision arthroplasty appear to be similar to those obtained by the same technique in revision hip surgery.     

Complications of titanium cranioplasty—a retrospective analysis of 174 patients

Background

Titanium cranioplasty (TC) has been associated with high complication rates, but abundant data are lacking. We aimed to determine the incidence and type of complications following TC and risk factors for complications.

Methods

A retrospective review was performed on 174 patients who underwent TC at two London units over a seven year period. Data were collected on demographics, primary pathology, perioperative details, complications and functional outcome. Skull defect size was estimated using 3-dimensional computed tomographic reconstructions.

Results

The overall complication rate was 26.4 % (46/174), and plate removal rate10.3 % (18/174). The commonest complication was infection, which accounted for 69 % of plate removals. Patients who had undergone craniectomy for trauma had a higher complication rate (35 vs 21 %; p?=?0.043) and plate removal rate (16 vs 7 %; p?=?0.049) than others. There was a non-significant trend towards the association of craniectomy-to-cranioplasty interval of 4–8 months with the lowest complication rate and shortest postoperative hospital stay. Patients with a skull defect larger than 100 cm² had the highest complication rate (p?<?0.001), highest plate removal rate (p?=?0.039), and longest postoperative hospital stay (p?=?0.019). Bifrontal versus unilateral cranioplasty was associated with a significantly higher complication rate (40 vs 14 %) and length of hospital stay (5.0 vs 2.9 days). There was no perioperative mortality and no change between pre-operative and post-operative functional outcome.

Conclusion

In the largest UK study on cranioplasty to date, we have demonstrated that size of defect, traumatic aetiology and bifrontal insertion are risk factors for complications. Our results suggest that the timing of cranioplasty may be important with late (> 12 months) TC associated with a higher rate of complications, although further prospective studies on the optimal timing of TC are required to establish the observed trend. Our data can help clinicians stratify risk to inform the consent process and aid pre-operative planning.     

Outcomes of the Rives–Stoppa technique in incisional hernia repair: ten years of experience

Background Use of the Rives–Stoppa (R–S) technique has markedly diminished recurrence rate. Our aim was to assess the outcomes of Iranian patients undergoing the R–S technique and to determine factors affecting recurrence rate and time. Methods Over a 10-year period, 86 open abdominal wall incisional hernia repairs were performed using the R–S technique. Prolene and Mersilene meshes were used. Main outcome measures were the rate and time of recurrence and mortality. Results Sixty-six women and 20 men underwent the R–S technique (mean age: 51.21 ± 13.01 years; mean follow up period: 67.60 ± 32.55 months). The total recurrence rate was 5.8%. Most of these occurred in the first 12 months of follow up. Mersilene was used in 61%. There was no correlation between hernia recurrence and age, gender, defect size, mesh size, mesh type, number of meshes used, type of operation, position of incision, seroma, respiratory complications, ICU admission, or wound complications (P > 0.05). Overall postoperative complication rate was 18.2%. Except for type of operation, there was no correlation between the factors mentioned and recurrence time. Cumulative 5 and 10-year recurrence rate were 4.2 and 12.5%, respectively. Conclusion The R–S technique is the most promising open technique, with low recurrence rates, excellent long-time results, and minimal serious morbidity. Age might be an important factor in recurrence rate.     

Metal/metal versus alumina/polyethylene: radio-clinical retrospective and comparative analysis of the first year of METASUL ™ use with 10 years follow-up

Aim

In 1994, I was given the opportunity to substitute a metal on metal pairing for an alumina/polyethylene pairing, the latter which I had been working with for a long time. Each year I reviewed 38 patients from my first year of practice (Triclot et al. in Etude radio-clinique comparative d’un couple metal-metal et d’un couple alumine-polyéthylene; 6 ans de recul. Hip’2002, Toulouse, 2002) and I will present the actual comparative results about this pairing.

Materials and methods

36 patients (38 hips) were summoned, all operated on between November 1994 and November 1995, implanted with a metal/metal pairing. All patients were under 65 years; 27 hips reviewed: Group 1. Identical summon of 38 randomly selected patients, operated on during the same timeframe, 65 years old or older than that, and all implanted with the same implants with the exception of the pairing (alumina/polyethylene); 14 hips reviewed: Group 2. Clinical results according to Merle d’Aubigné and Harris. Radiological results: Barrack grading change; zone 7 modification; cup migration.

Results

Causes for non-review in both groups. No failure because of the pairing. Survival curve: 100% of both groups regarding the aseptif failure occurrence. Clinical results: identical in both groups. Radiological results: Barrack Group 1: 7.40%. Barrack Group 2: 50%. Zone 7 modification: Group 1—14.8%; Group 2—85.7%. Cup migration: non-significant results. Beyond the disappointment of not having able to re-examine a large number of patients, 10 years after their surgery, we can note the absence of specific complications with regard to the pairing, as well as a significant decrease in all signs of suffering from the interface related to the diffusion of debris from the pairing in the effective joint space. The rare results of the comparative studies (Doerig et al. in World Tribology Forum in arthroplasty, Bern, Toronto 2001; Migaud et al. in J Arthroplasty 19:23–28, 2004; Doerig et al. in Hip Int 16(2):95, 2006; Knahr et al. Hip Int 16(2):97, 2006) confirm the results of hip simulator studies (Clarke et al. in Metal on metal bearing, Bern, Toronto, 1999). The mechanical reliability of the metal on metal pairing in this METASUL? tribologic configuration and with this cup is confirmed for 10 years as an alternative to a pairing creating typical polyethylene debris (Delaunay in Rev Chir Orthop 91:70–78, 2005); and I am putting forward three questions: Should this pairing be implanted on a potentially pregnant young woman (Brodner et al. in J Arthroplasty 19(sup 3):102–106, 2004)? Should there be a biological monitoring instated to confirm or remove concerns about of the future of metal ions (Lazenec et al. in J Bone Joint Surg 84B(supp1):53–54, 2002)? Should this mechanical reliability allow me to use bigger diameters (Riecker et al. in Orthop Clin North Am 36(2):135–142, 2005)?     

Epidemiology and outcome analysis of facial burns: A retrospective multicentre study 2011–2015

BackgroundThe head and neck regions are frequent sites of burns, but few studies have analysed and reported the epidemiology of facial burns. As the face is the centre of one’s identity and persona, facial injuries often result in physical and psychological morbidity. The aim of this article is to describe the epidemiology and outcome of facial burns in China and to suggest future preventive strategies.MethodsThis retrospective analysis included all patients with facial burns in a database at eight institutions from 2011–2015. The data collected included sex, age, month distribution, aetiology, location, presence of inhalation injury, total burn surface area, burn surface area with full-thickness and outcome including Post-traumatic stress disorder Checklist-Civilian Version scores and mortality. SPSS 19.0 software was used to analyse the data.ResultsA total of 1126 patients were included; 65.63% (739) had facial burns, of which 546 (73.88%) were male patients and 193 (26.12%) were female patients. Predictors of facial burns were being of male sex, working-related place, flame burns, total body surface area, and full-thickness burns. In addition, total body surface area and full-thickness burns increased the risk of poor prognosis for post-traumatic stress disorder and mortality.ConclusionsFacial burns benefit not only the healing of wound, but also the prevention of their incidence and PTSD symptom. This study may contribute to the elaboration of strategies to prevent facial burns and the establishment of a nationwide burn database in China.     

Transplant quality in Italy: analysis of the 1995–2000 period

Evaluation of outcomes is a major step in quality assessment of any health process. In the transplant field, the evaluation of outcome is extremely important for both patients growing demand for health and for the joint commitment the transplant process requires. In this study, the outcome of 12,647 transplants, carried out between 1995 and 2000 were analysed. Graft survival at 5 years was 79% for kidney, 67% for liver, 72% for heart and 38% for lung. Patient survival was 92% for kidney, 76% for liver, 72% for heart and 38% for lung. In comparison to other international case records [Collaborative Transplant Study (CTS) and The United Network for Organ Sharing (UNOS)], results are similar or even better for all transplant programmes. As a whole, survival after solid organ transplant in Italy ranks among the best for both donations and transplantation. The quality of transplants carried out is above European standards. Nevertheless, the growing health needs of patients require improvement in both the procurement process and in the use of available organs.     

British Orthopaedic Foot Surgery Society Meeting, 16–17 November 2000

This is a report on the British Orthopaedic Foot Surgery Society (BOFSS) meeting which was held on 16–17 November 2000, held at the Medical Education Centre, Northern General Hospital, organized and chaired by the President of BOFSS, Mr T. W. D. Smith. I am currently on an orthopaedic/podiatric surgical traineeship with Mr Smith and an invitation was extended to me by the President to attend the BOFSS meeting.     

The rasterstereographic–dynamic analysis of posture in adolescents using a modified Matthiass test

The Matthiass posture test is a clinical test to detect posture changes in children and adolescents. Aim of this study was to objectify this test using a dynamic rasterstereographic measuring device. We examined 31 healthy athletes during a modified Matthiass test with a dynamic rasterstereographic measuring system. Hereby the trunk inclination, kyphosis and lordosis angle were measured. The trunk inclination decreased by about 50% of the basic value just by raising the arms. Additional weight loads of only 5% body weight (bw) resulted in significant changes of the posture (lordosis and kyphosis angle) during this test. With this rasterstereographic measuring device it seems to be possible to determine spinal posture changes under dynamic conditions. The results suggest that additional weights of 5% bw during the Matthias-test are enough to create significant deviations in posture parameters, even in healthy subjects.     

Associations of cephalad drainage in neonatal veno-venous ECMO – A mixed-effects,propensity score adjusted retrospective analysis of 20 years of ELSO data

BackgroundNeurologic complications can occur during neonatal Veno-Venous (VV) ECMO. The addition of a cephalad drainage cannula (i.e., VVDL+V) to dual lumen cannulation (i.e., VVDL) has been advocated to reduce such complications, but previous studies have presented mixed results.MethodsData from the ECMO Registry of the Extracorporeal Life Support Organization was used to extract all neonates (≤28 days old) who underwent VV ECMO for respiratory support between 2000 and 2019. Primary outcomes were mortality, conversion to Veno-Arterial (VA) ECMO, pump flows, and complications. A mixed-effects, propensity score adjusted analysis was performed.Results4,275 neonates underwent VV ECMO, 581 (13.6%) via VVDL+V cannulation, and 3,694 (86.4%) via VVDL. On unadjusted analyses, VVDL+V patients had higher rates of mortality (25.5% vs 19.0%, p<0.001), conversion to VA ECMO (14.5% vs 4.1%, p<0.001), and higher pump flows at 4 h from ECMO initiation (112.7 vs 105.5 mL/Kg/min, p<0.001), but lower at 24 h (100.3 vs 104.0 mL/Kg/min, p = 0.004), and a higher proportion of them experienced hemorrhagic (29.3% vs 18.3%, p<0.001), cardiovascular (60.8% vs 45.8%, p<0.001), and mechanical (42.5% vs 32.6%, p<0.001) complications compared to VVDL patients. After adjusting for propensity scores and the multi-level nature of ELSO data, there were no differences in neurologic outcomes, pump flows, or mortality. Rather, VVDL+V cannulation was associated with higher rates of conversion to VA ECMO (adjusted odds ratio [AOR] 43.3, 95% CI 24.3 – 77.4, p<0.001), and increased mechanical (AOR 2.2, 95% CI 1.6 – 3.0, p<0.001) and hemorrhagic (AOR 2.0, 95% CI 1.4 – 3.0, p<0.001) complications.ConclusionsIn this analysis, VVDL+V cannulation was not associated with any improvement in neurologic outcomes, pump flows, or mortality, but was rather associated with higher rates of conversion to Veno-Arterial ECMO, mechanical, and hemorrhagic complications.     

A retrospective and consecutive analysis of the epidemiology and management of spinal cavernomas over the last 20 years in a single center

Spinal cavernous malformations (SCM) are rare lesions often presenting with acute onset of symptoms and progressive neurological deterioration due to hemorrhage into the spinal cord. With the aid of modern techniques, their surgical removal became much safer. The present study was undertaken to analyze the outcome of our series of surgically and conservatively treated patients with SCM. Over a period of 20 years, 20 surgically treated and 5 conservatively managed patients with spinal cavernous malformations were identified and enrolled into this analysis. Demographic data, clinical symptoms, localization and extension of the cavernoma, as well as pre- and postoperative neurological status were obtained. The clinical status was assessed using the Frankel score. Patients were followed up clinically and by MRI. Before surgery, 90 % (18/20) of our surgical patients were classified as Frankel D (93.8 %), whereas two patients (10 %) were graded C. None of the patients had a worse Frankel score at the time of discharge. Eighty percent of them (16 cases) remained unchanged, and 20 % (4 patients) improved during the first follow-up (mean 6.3 months, range 2–17 months). All improved patients had a superficially located SCM and were operated early (≤3 months). No worsening was observed during extended follow-up (range 9–134 months, mean 44.7 months). Five nonsurgically treated patients showed no significant clinical deterioration over a period of 6.7 years (mean, range 2.9–8 years). SCM localization and number of involved segments had no influence on outcome. Our data show that SCM can be resected with favorable neurological outcome by using intraoperative neuromonitoring. Within the follow-up period, patients treated conservatively remained in a stable neurological condition.     

Primary Ewing’s sarcoma of cranial bones: analysis of ten patients

Objective  

Ewing’s sarcomas are the second most common bone tumors in children and primary involvement of the cranium is uncommon. We analyzed retrospectively the data of ten patients with this rare subset of disease, who had been treated at our institute since 2005. Our aim was to assess the outcomes, recurrence rates and the selection of appropriate treatment methods.