The Hug-up Test: A New,Sensitive Diagnostic Test for Supraspinatus Tears

Background:

The supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection of a supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests.

Methods:

Between November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can (EC) test, full can (FC) test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically for their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer.

Results:

The prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity (94.1%), with a low negative likelihood ratio (NLR, 0.08) and comparable specificity (76.6%) compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test (z = 1.438, P = 0.075) or the FC test (z = 1.498, P = 0.067). The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position (χ² = 0.578, P = 0.898) and size (Fisher''s exact test, P > 0.999) compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823.

Conclusions:

The hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional clinical tests and could, therefore, improve the diagnosis of supraspinatus tears in clinical settings.     

Changes with time in skin temperature of the shoulders in healthy controls and a patient with shoulder-hand syndrome

Background

Abnormal skin temperature in the shoulder is caused by various diseases. A thermography is unable to capture temperature changes over time. In contrast, a Thermocron is an effective measuring device to monitor temperature changes over time.

Purposes

The purposes of this study employing a Thermocron were to measure shoulder skin temperature over time in healthy subjects and to detect shoulder skin temperature abnormalities in a patient with shoulder-hand syndrome.

Subjects and methods

Subjects comprised 10 healthy volunteers (20 shoulders; 4 men and 6 women, mean age 54 years). For measurements, a Thermocron was attached on both shoulders. Measurements were made from 21.00 to 07.00 the following morning at 15-minute intervals.

Results

Gradual difference in right and left shoulder skin temperature was observed with the timing of measurements but no significant difference was apparent, i.e. dominant side 34.9 ± 0.8°C, non-dominant side 34.9 ± 0.9°C (P = 0.28).

Presentation of a case with shoulder-hand syndrome

A 54-year-old woman with the diagnosis of rotator cuff tear underwent surgical treatment of rotator cuff repair, but the pain of the operated shoulder persisted due to phase 1 shoulder-hand syndrome. In postoperative week 3, skin temperature measurement using Thermocrons demonstrated a significant decrease in temperature on the operated side (affected side 34.3 ± 0.4°C, healthy side 35.2 ± 0.3°C; P < 0.05).

Conclusion

The changing of the skin temperature during night-time was successfully recorded both in the healthy subjects and a case with shoulder-hand syndrome using a Thermocron.     

Radiographic indices in one hundred fifty normal Iranian wrists

Background

Radiography is the most widely available imaging modality. Precise evaluations of wrist x-ray can help diagnosis and evaluate the prognosis of many wrist disorders.

Methods

We measured length, angles and indices in 150 posteroanterior and lateral wrist x-rays to determine normal dimensions and variations according to age and sex. All x-rays were made with standard exposure, with the wrist and forearm in a neutral position.

Results

The average carpal height ratio was 0.52±0.03 with the Youm method and 1.5±0.09 with the Nattrass method. Mean ulnar variance was +0.99±1.6 mm and mean radial inclination was 25±4 degrees. The average radial tilt was 10±5.1 degrees. Mean scapholunate angle was 50±8.4 degrees (normal range 40-60).

Conclusion

Carpal height, third metacarpal and capitate length were smaller in women than in men. There was a significant positive relationship between all dimensions. Our data base may be used to follow-up in conditions such as carpal instability, osteoarthritis and osteonecrosis, as well as for clinical research.     

Posterior Reduction and Monosegmental Fusion with Intraoperative Three-dimensional Navigation System in the Treatment of High-grade Developmental Spondylolisthesis

Background:

The treatment of high-grade developmental spondylolisthesis (HGDS) is still challenging and controversial. In this study, we investigated the efficacy of the posterior reduction and monosegmental fusion assisted by intraoperative three-dimensional (3D) navigation system in managing the HGDS.

Methods:

Thirteen consecutive HGDS patients were treated with posterior decompression, reduction and monosegmental fusion of L5/S1, assisted by intraoperative 3D navigation system. The clinical and radiographic outcomes were evaluated, with a minimum follow-up of 2 years. The differences between the pre- and post-operative measures were statistically analyzed using a two-tailed, paired t-test.

Results:

At most recent follow-up, 12 patients were pain-free. Only 1 patient had moderate pain. There were no permanent neurological complications or pseudarthrosis. The magnetic resonance imaging showed that there was no obvious disc degeneration in the adjacent segment. All radiographic parameters were improved. Mean slippage improved from 63.2% before surgery to 12.2% after surgery and 11.0% at latest follow-up. Lumbar lordosis changed from preoperative 34.9 ± 13.3° to postoperative 50.4 ± 9.9°, and 49.3 ± 7.8° at last follow-up. L5 incidence improved from 71.0 ± 11.3° to 54.0 ± 11.9° and did not change significantly at the last follow-up 53.1 ± 15.4°. While pelvic incidence remained unchanged, sacral slip significantly decreased from preoperative 32.7 ± 12.5° to postoperative 42.6 ± 9.8°and remained constant to the last follow-up 44.4 ± 6.9°. Pelvic tilt significantly decreased from 38.4 ± 12.5° to 30.9 ± 8.1° and remained unchanged at the last follow-up 28.1 ± 11.2°.

Conclusions:

Posterior reduction and monosegmental fusion of L5/S1 assisted by intraoperative 3D navigation are an effective technique for managing high-grade dysplastic spondylolisthesis. A complete reduction of local deformity and excellent correction of overall sagittal balance can be achieved.     

Osteoid osteoma of the hand and wrist: a report of 25 cases

Background

The hand and wrist bones are infrequent sites for osteoid osteoma, and its diagnosis can be difficult. This paper reports 25 cases of osteoid osteoma in the hand and wrist.

Methods

Records of the 25 patients who had pathological conditions of osteoid osteoma of the hand and wrist were reviewed and analyzed.

Results

Twenty-five cases of osteoid osteoma of the hand and wrist were treated in 20 years period. The average age was 25.2±7.6 years (range, 16 to 46 years) with men to women and right to left side ratio of 5.25 and 4 respectively. The most common site was in the proximal phalanx (ten cases). The diagnosis was made using x-rays, three- phase Technetium bone scans, CT, and MRI and all the diagnoses were confirmed by histological examination. The average time from the onset of symptom to successful treatment was 16.3±11.1 months, and at a mean follow-up of 36.6±46.9 mouths. Five recurrences of disease took place in which three of them were operated elsewhere. All five patients subsequently were treated and cured by reoperation.

Conclusion

Osteoid osteoma is relatively rare lesions in the hand and wrist that can be a persistent source of hand and wrist pain. Patients under age of 40 who have otherwise unexplained pain should be evaluated.     

Short-term result of arthroscopic synovial excision for dorsal wrist pain in hyperextension associated with synovial hypertrophy

INTRODUCTION

Arthroscopic excision of the hypertrophic dorsal synovium is performed on patients with dorsal wrist pain in hyperextension. Although dorsal wrist impingement has been described in cadaveric studies, to our knowledge, there is no published clinical data on its treatment with arthroscopic synovial excision. Herein, we present the results of arthroscopic management of this condition in our hospital.

METHOD

A total of 13 patients underwent arthroscopic excision of the hypertrophic dorsal impinging synovium. All patients presented with the cardinal symptom of dorsal-radial wrist pain in extreme extension. The diagnoses were made after excluding other causes and confirmed on wrist arthroscopy. Arthroscopy was offered after nonoperative measures failed. The mean postoperative follow-up period was 14 (range 6–31) months.

RESULTS

Mean pre-and postoperative quick Disabilities of the Arm, Shoulder and Hand scores were 49 (range 34–82) and 17 (range 0–48), respectively; paired t-test revealed a significant difference between the two (p < 0.001). Mean postoperative flexion-extension arc and radial-ulnar deviation arc were 120º and 46º, respectively. Postoperatively, one patient developed complex regional pain syndrome, with tethering of the dorsal branch of the ulnar nerve, which required surgical release, while another patient required revision arthroscopic excision of the impinging tissue. Both patients had good postoperative outcomes.

CONCLUSION

When treating patients with dorsal wrist pain, dorsal wrist impingement caused by synovial hypertrophy should be included in the differential diagnosis. Arthroscopic excision of the impinging synovium can achieve reliable pain relief with significant functional improvement in the short term, although further research on its long-term benefits is required.     

Comparison of Clinical Outcome of Autograft and Allograft Reconstruction for Anterior Cruciate Ligament Tears

Background:

Hamstring (HS) autograft and bone-patellar tendon-bone allograft are the most common choice for reconstruction of anterior cruciate ligament (ACL). There was a little report about the clinical outcome and difference of arthroscopic ACL reconstruction using allograft and autograft. This study aimed to compare the clinical outcome of autograft and allograft reconstruction for ACL tears.

Methods:

A total of 106 patients who underwent surgery because of ACL tear were included in this study. The patients were randomly divided into two groups, including 53 patients in each group. The patients in group I underwent standard ACL reconstruction with HS tendon autografts, while others in group II underwent reconstruction with bone-patellar tendon-bone allograft. All the patients were followed up and analyzed; the mean follow-up was 81 months (range: 28–86 months). Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC), Lysholm scores, physical instability tests, and patient satisfaction questionnaires. The complication rates of both groups were compared. Tibial and femoral tunnel widening were assessed using lateral and anteroposterior radiographs.

Results:

At the end of follow-up, no significant differences were found between the groups in terms of IKDC, Lysholm scores, physical instability tests, patient satisfaction questionnaires, and incidences of arthrofibrosis. Tibial and femoral tunnel widening was less in the HS tendon autografts. This difference was more significant on the tibial side.

Conclusions:

In the repair of ACL tears, allograft reconstruction is as effective as the autograft reconstruction, but the allograft can lead to more tunnel widening evidently in the tibial tunnel, particularly.     

Spinal Cord Kinking in Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Background:

Ossification of the ligamentum flavum (OLF) is being increasingly recognized as a cause of thoracic myelopathy. This study was to describe a rare clinical entity of spinal cord kinking (SK) in thoracic myelopathy secondary to OLF.

Methods:

The data of 95 patients with thoracic myelopathy secondary to OLF were analyzed retrospectively. The incidence and location of SK were determined using preoperative magnetic resonance imaging (MRI). The clinical presentation and radiological characteristics in patients with SK were analyzed. Posterior en bloc laminectomy with OLF was performed, and the surgical results were evaluated.

Results:

SK was found in seven patients (7.4%) based on preoperative MRI. The patients included one male and six females with an average age of 55.6 years (range, 48–64 years). Five patients presented with radiculomyelopathy and two presented with typical thoracic myelopathy of spastic paraparesis. In all cases, the kinking was located just above the end of the spinal cord where the conus medullaris (CM) was compressed by the OLF. The degree of SK varied from mild to severe. The tip of the CM was located between the upper third of T11 to the lower third of L1, above the lower edge of L1. With an average follow-up of 30.4 months, the modified Japanese Orthopedic Association score significantly improved from 5.7 ± 1.8 preoperatively to 8.9 ± 1.4 postoperatively (t = 12.05; P < 0.0001) with an improvement rate of 63.1 ± 12.3%.

Conclusions:

SK is a rare radiological phenomenon. It is typically located at the thoracolumbar junction, where the CM is compressed by the OLF. Our findings indicate that these patients may benefit from a posterior decompressive procedure.     

Factors related to successful outcome of conservative treatment for rotator cuff tears

Background

Much controversy exists as to the management of full-thickness tears of the rotator cuff. Not all patients with rotator cuff tears require surgical treatment. We have little information whether there are factors that are related to successful outcome of conservative treatment.

Aim

The purpose of this study was to determine the factors related to the successful outcome following conservative treatment.

Methods

This study included 123 shoulders in 118 patients with full-thickness tears of the rotator cuff diagnosed by high-resolution magnetic resonance imaging with a microscopy coil. All patients were treated conservatively for at least 3 months. Clinical symptoms improved in 65 shoulders in 62 patients by conservative treatment (conservative group), but remained unchanged or aggravated in 58 shoulders in 56 patients, who eventually underwent surgical repair (surgical group).

Results

The following parameters showed significant differences: 1) integrity of the intramuscular tendon of the supraspinatus (24.1% in the surgical group and 58.4% in the conservative group showed an intact intramuscular tendon); 2) supraspinatus muscle atrophy (occupancy ratio was 69.8% in the surgical group and 78.0% in the conservative group); 3) impingement sign (positive in 79.3% in the surgical group and 30.7% in the conservative group); and 4) external rotation angle (35.0 degrees in the surgical group and 52.2 degrees in the conservative group). The success rate of conservative treatment was 87% in the cases with at least three of these four factors.

Conclusion

These four factors are useful in selecting patients who will respond well to conservative treatment before initiating the treatment.     

Surgical Fixation of Fourth and Fifth Metacarpal Shaft Fractures with Flexible Intramedullary Absorbable Rods: Early Clinical Outcomes and Implications

Background:

To avoid the irritation of tendons and soft tissues as well as hardware-related problems, we designed an intramedullary fixation with bioabsorbable rods for the treatment of the metacarpal shaft fractures.

Methods:

Five patients with nine shaft fractures of the fourth and fifth metacarpi were treated with intramedullary absorbable implants and followed up with an average of 4.2 months postoperatively.

Results:

At final follow-up, all patients achieved fracture union with no signs of inflammatory or subcutaneous effusion. There was no shortening, angulatory, or rotatory deformity. There was almost full active extension range of motion (ROM) of the metacarpophalangeal joints while the active flexion ROM of these joints was 80.7 ± 9.6°. Compared with the contralateral hand, the grip strength of the injured hand was 94.0 ± 9.6%. X-rays showed that the arch of the second to fifth metacarpal heads was smooth. There were no intramedullary lytic changes and soft tissue swellings.

Conclusion:

The intramedullary absorbable implants are a safe, simple, and practical treatment for fourth and fifth metacarpal fractures with good early clinical outcomes and no significant complications.     

Do Different Cyclooxygenase Inhibitors Impair Rotator Cuff Healing in a Rabbit Model?

Background:

The effect of selective and non-selective cyclooxygenase (COX) inhibitors on tendon healing was variable. The purpose of the study was to evaluate the influence of non-selective COX inhibitor, ibuprofen and flurbiprofen axetil and selective COX-2 inhibitor, celecoxib on the tendon healing process in a rabbit model.

Methods:

Ninety-six New Zealand rabbits were used as rotator cuff repair models. After surgery, they were divided randomly into four groups: Ibuprofen (10 mg·kg⁻¹·d⁻¹), celecoxib (8 mg·kg⁻¹·d⁻¹), flurbiprofen axetil (2 mg·kg⁻¹·d⁻¹), and control group (blank group). All drugs were provided for 7 days. Rabbits in each group were sacrificed at 3, 6, and 12 weeks after tendon repair. Tendon biomechanical load failure tests were performed. The percentage of type I collagen on the bone tendon insertion was calculated by Picric acid Sirius red staining and image analysis. All data were compared among the four groups at the same time point. All data in each group were also compared across the different time points. Qualitative histological evaluation of the bone tendon insertion was also performed among groups.

Results:

The load to failure increased significantly with time in each group. There were significantly lower failure loads in the celecoxib group than in the control group at 3 weeks (0.533 vs. 0.700, P = 0.002), 6 weeks (0.607 vs. 0.763, P = 0.01), and 12 weeks (0.660 vs. 0.803, P = 0.002), and significantly lower percentage of type I collagen at 3 weeks (11.5% vs. 27.6%, P = 0.001), 6 weeks (40.5% vs. 66.3%, P = 0.005), and 12 weeks (59.5% vs. 86.3%, P = 0.001). Flurbiprofen axetil showed significant differences at 3 weeks (failure load: 0.600 vs. 0.700, P = 0.024; percentage of type I collagen: 15.6% vs. 27.6%, P = 0.001), but no significant differences at 6 and 12 weeks comparing with control group, whereas the ibuprofen groups did not show any significant difference at each time point.

Conclusions:

Nonsteroidal anti-inflammatory drugs can delay tendon healing in the early stage after rotator cuff repair. Compared with nonselective COX inhibitors, selective COX-2 inhibitors significantly impact tendon healing.     

Sonographic assessment of the carotid intima-media thickness on B-mode ultrasonography in a Nigerian population

Background:

Hypertension is a common health problem and a major risk factor of cardiovascular disease. The most important mechanism by which hypertension acts as a cardiovascular risk factor is the induction of arteriosclerosis. The early phase of atherosclerosis before its clinical manifestation can be studied using B-mode ultrasonography.

Aims and Objectives:

This study evaluated the intima-media thickness of the common carotid artery (CCA), carotid intima-media thickness (CIMT) of subjects with essential hypertension as a way of detecting these early changes of atherosclerosis.

Subjects and Methods:

The study was performed on 200 subjects with newly diagnosed hypertension and 100 apparently normal controls that were consecutively recruited by a cardiologist. An ultrasound examination of both CCA were done to obtain the CIMT. Data were analyzed using the SPSS data analysis software.

Results:

The CIMT of males were greater in the hypertensive group compared to the controls (0.10 ± 0.02 cm vs. 0.077 ± 0.02 cm [P < 0.0001] and 0.10 ± 0.02 cm vs. 0.078 ± 0.02 cm [P < 0.0001] for the right and left sides, respectively). The female group showed a similar pattern of results (0.09 ± 0.02 cm vs. 0.072 ± 0.02 cm [P < 0.0001] and 0.1 ± 0.02 cm vs. 0.076 ± 0.02 cm [P < 0.0001] for the right and left sides respectively).

Conclusion:

A statistically significant increase in CIMT was noted in both male and female hypertensives in comparison to a normal population.     

Effect of Pilates exercises on postpartum maternal fatigue

INTRODUCTION

Postpartum fatigue is a pervasive phenomenon and often affects mothers immediately after delivery. The present study aimed to assess the effect Pilates home exercises had on postpartum maternal fatigue.

METHODS

A total of 80 women participated in our clinical trial study. The women were randomly divided into two groups – the intervention group (n = 40) and the control group (n = 40). In the intervention group, the women performed Pilates exercises five times a week (30 min per session) for eight consecutive weeks. The first session was conducted 72 hours after delivery. The control group did not receive any intervention. Each woman’s level of fatigue was evaluated at hospital discharge (as a baseline), and at four and eight weeks after delivery, using the standard Multidimensional Fatigue Inventory (MFI-20) questionnaire and repeated measures analysis.

RESULTS

During the eight weeks of follow-up, we found that the intervention group had lower mean MFI-20 scores than the control group with regard to general fatigue (7.80 ± 2.07 vs. 12.72 ± 1.79; p < 0.001), physical fatigue (7.12 ± 1.41 vs. 10.42 ± 2.02; p < 0.001), reduced activity (6.95 ± 1.35 vs. 11.27 ± 1.70; p < 0.001), reduced motivation (6.20 ± 1.01 vs. 9.80 ± 2.04; p < 0.001) and mental fatigue (6.85 ± 1.45 vs. 10.72 ± 1.98; p < 0.001).

CONCLUSION

The present study’s findings show that physical exercise can significantly reduce postpartum maternal fatigue in all subscales.     

Semi-quantitative Assessment of Brain Maturation by Conventional Magnetic Resonance Imaging in Neonates with Clinically Mild Hypoxic-ischemic Encephalopathy

Background:

Mild hypoxic-ischemic encephalopathy (HIE) injury is becoming the major type in neonatal brain diseases. The aim of this study was to assess brain maturation in mild HIE neonatal brains using total maturation score (TMS) based on conventional magnetic resonance imaging (MRI).

Methods:

Totally, 45 neonates with clinically mild HIE and 45 matched control neonates were enrolled. Gestated age, birth weight, age after birth and postmenstrual age at magnetic resonance (MR) scan were homogenous in the two groups. According to MR findings, mild HIE neonates were divided into three subgroups: Pattern I, neonates with normal MR appearance; Pattern II, preterm neonates with abnormal MR appearance; Pattern III, full-term neonates with abnormal MR appearance. TMS and its parameters, progressive myelination (M), cortical infolding (C), involution of germinal matrix tissue (G), and glial cell migration bands (B), were employed to assess brain maturation and compare difference between HIE and control groups.

Results:

The mean of TMS was significantly lower in mild HIE group than it in the control group (mean ± standard deviation [SD] 11.62 ± 1.53 vs. 12.36 ± 1.26, P < 0.001). In four parameters of TMS scores, the M and C scores were significantly lower in mild HIE group. Of the three patterns of mild HIE, Pattern I (10 cases) showed no significant difference of TMS compared with control neonates, while Pattern II (22 cases), III (13 cases) all had significantly decreased TMS than control neonates (mean ± SD 10.56 ± 0.93 vs. 11.48 ± 0.55, P < 0.05; 12.59 ± 1.28 vs. 13.25 ± 1.29, P < 0.05). It was M, C, and GM scores that significantly decreased in Pattern II, while for Pattern III, only C score significantly decreased.

Conclusions:

The TMS system, based on conventional MRI, is an effective method to detect delayed brain maturation in clinically mild HIE. The conventional MRI can reveal the different retardations in subtle structures and development processes among the different patterns of mild HIE.     

Effect of Intravascular Ultrasound-assisted Thoracic Endovascular Aortic Repair for “Complicated” Type B Aortic Dissection

Background:

Intravascular ultrasound (IVUS) examination can provide useful information during endovascular stent graft repair. However, its actual clinical utility in thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (type B-AD) remains unclear, especially in complicated aortic dissection. We evaluated the effect of IVUS as a complementary tool during TEVAR.

Methods:

From September 2011 to April 2012, we conducted a prospective cohort study of 47 consecutive patients with “complicated” type B-AD diagnosed. We divided the patients into two groups: IVUS-assisted TEVAR group and TEVAR using angiography alone group. The general procedure of TEVAR was performed. We evaluated the perioperative and follow-up events. Patient demographics, comorbidities, preoperative images, dissection morphology, details of operative strategy, intraoperative events, and postoperative course were recorded.

Results:

A total of 47 patients receiving TEVAR were enrolled. Among them (females, 8.51%; mean age, 57.38 ± 13.02 years), 13 cases (27.66%) were selected in the IVUS-assisted TEVAR group, and 34 were selected in the TEVAR group. All patients were symptomatic. The average diameter values of IVUS measurements in the landing zone were greater than those estimated by computed tomography angiography (31.82 ± 4.21 mm vs. 30.64 ± 4.13 mm, P < 0.001). The technique success rate was 100%. Among the postoperative outcomes, statistical differences were only observed between the IVUS-assisted TEVAR group and TEVAR group for total operative time and the amount of contrast used (P = 0.013 and P < 0.001, respectively). The follow-up ranged from 15 to 36 months for the IVUS-assisted TEVAR group and from 10 to 35 months for the TEVAR group (P = 0.646). The primary endpoints were no statistical difference in the two groups.

Conclusions:

Intraoperative IVUS-assisted TEVAR is clinically feasible and safe. For the endovascular repair of “complicated” type B-AD, IVUS may be helpful for understanding dissection morphology and decrease the operative time and the amount of contrast used.     

A comparative study of the oral hygiene status of smokers and non-smokers in Ibadan,Oyo state

Aims:

The aim of this study was to assess the effect of tobacco smoking on gingival health and the oral hygiene status of respondents.

Materials and Methods:

A cross-sectional survey of 213 adults from three communities in the Ibadan North local government was carried out. Respondents were divided into two groups comprising of 117 smokers (cases) and 96 non-smokers (control). Intra oral examination was done using the Simplified Oral Hygiene Index (OHI-S) and Gingival index (GI).

Results:

The mean age of the smokers was 31.2 ± 12.6 years and that of the non-smokers 32.8 ± 9.5 years. The mean Simplified Oral Hygiene Index (OHI-S) was 1.15 ± 0.51 for the non-smokers and 2.19 ± 0.62 for the smokers (P < 0.05). The mean GI was 1.06 ± 0.55 for the non-smokers and 1.62 ± 0.58 for the smokers (P < 0.05).

Conclusion:

The study shows that smoking is associated with increased severity of gingival disease. It is, therefore, recommended that smokers should be encouraged to visit a dentist for preventive procedure more regularly than the non-smokers and better still, smokers should be encouraged to quit smoking as gingival disease is not without consequences if allowed to persist.     

Application of Minimum Effective Cuff Inflating Volume for Laryngeal Mask Airway and its Impact on Postoperative Pharyngeal Complications

Background:

High intracuff pressure can cause severe pharyngeal complications including sore throat or hoarseness after laryngeal mask airway (LMA) removal postoperatively. Though the application of minimum effective cuff inflating volume is suggested to maintain airway sealing and adequacy of ventilation for patients receiving general anesthesia with LMA at lower level of the intracuff pressure, it is currently not a standard care in most of the anesthetic departments. In this study, the minimum effective cuff inflating volume was determined for classic LMA Well Lead™ (Well Lead Medical Co., Ltd., China) and its impact on postoperative pharyngeal complications was also explored.

Methods:

Patients with American Society of Anesthesiologists physical status (I–III) undergoing the short-duration urological surgery were recruited in this trial. First, the minimum effective cuff inflating volume was determined for size 4 or 5 LMA Well LeadTM in the study 1. Immediately following placement and confirmation of ideal LMA position, the cuff was inflated with 5, 7, 10 ml of air and up to 30 ml at 5 ml increment. The intracuff pressure, oropharyngeal leak pressure (OLP), and inspiratory peak airway pressure under positive pressure ventilation at the corresponding cuff volume as indicated above were recorded. Second, the enrolled patients were randomly allocated into minimum effective cuff inflating volume group (MC) and routine care (RC) group in the study 2. The minimum effective cuff inflating volume was applied and maintained in MC group, whereas the cuff volume was inflated with half of the maximum cuff inflating volume recommended by manufacturer in RC group throughout the surgical procedure and stay in postanesthesia care unit prior to LMA removal. The incidence of pharyngeal complications at 0, 2, 24, and 48 h after removal of LMA and other intra-operative adverse events were also documented.

Results:

The intracuff pressure varied with the cuff inflating volume in a positive linear correlation manner (Y = 11.68X − 42.1, r² = 0.9191) under the range of 5–30 ml for size 4 LMA. In similar with size 4 LMA, the data were also showed the linear relationship between the intracuff pressure and the cuff inflating volume (Y = 7.39X − 10.9, r² = 0.8855) for size 5 LMA. The minimal effective cuff inflating volume for size 4 or 5 LMA was 7–9 ml in combination of considering OLP needed to maintain airway sealing during intermittently positive pressure ventilation. The intracuff pressure in MC group was lower compared with RC group (63.0 ± 3.7 vs. 126.4 ± 24.0 cmH₂O for size 4 LMA; 55.6 ± 2.4 vs. 138.5± 26.8 cmH₂O for size 5 LMA; P < 0.0001). The incidence of pharyngeal adverse events was lower in MC group versus the RC group at 2, 24 h after LMA removal.

Conclusions:

The relationship between the cuff inflating volume and the intracuff pressure for size 4 or 5 LMA Well Lead™ is in a linear correlation manner at the range of 5–30 ml. The minimal cuff inflating volume is adequate for satisfactory airway sealing and consequently associated with lower incidence of postoperative pharyngeal complications for LMA Well Lead.™     

Evaluation of the Effects of Standard Rescue Procedure on Severe Trauma Treatment in China

Background:

This study aimed to evaluate the effects of standard rescue procedure (SRP) in improving severe trauma treatments in China.

Methods:

This study was conducted in 12 hospitals located in geographically and industrially different cities in China. A standard procedure on severe trauma rescue was established as a general rule for staff training and patient treatment. A regional network (system) efficiently integrating prehospital rescue, emergency room treatments, and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments. Treatment outcomes were compared between before and 1 year after the implementation of the SRP.

Results:

The outcomes of a total of 74,615 and 12,051 trauma cases were collected from 12 hospitals before and after the implementation of the SRP. Implementation of the SRP led to efficient cooperation and information sharing of different treatment services. The emergency response time, prehospital transit time, emergency rescue time, consultation call time, and mortality rate of patients were 24.24 ± 4.32 min, 45.69 ± 3.89 min, 6.38 ± 1.05 min, 17.53 ± 0.72 min, and 33.82% ± 3.87% (n = 441), respectively, before the implementation of the standardization and significantly reduced to 10.11 ± 3.21 min, 22.39 ± 4.32 min, 3.26 ± 0.89 min, 3.45 ± 0.45 min, and 20.49% ± 3.11%, separately (n = 495, P < 0.05) after that.

Conclusions:

Staff training and SRP can significantly improve the efficiency of severe trauma treatments in China.     

Morphology of distal radius curvatures: a CT-based study on the Malaysian Malay population

INTRODUCTION

The purpose of this study was to examine the differing curves of the volar distal radius of healthy Malaysian Malays, so as to obtain detailed morphological information that will further the understanding of volar plate osteosynthesis in Malaysian Malays.

METHODS

Computed tomography with three-dimensional reconstruction was performed on the wrists of 16 healthy Malaysian Malay volunteers. Profile measurements were made using a software program. A novel parameter, the pronator quadratus curve angle, was explored and introduced in this study. Interclass correlation coefficients were calculated to assess the level of agreement between the data collected by the principal investigator and that collected by an independent radiologist.

RESULTS

The mean ± standard deviation of the arc radii on the radial aspect was 17.50° ± 5.40°, while the median (interquartile range [IQR]) of the arc radii on the ulnar aspect was 25.27° (IQR 5.80°). The mean ± standard deviation of the curvature of the pronator quadratus line was 40.52° ± 2.48°. The arc radii on the radial aspect was significantly lower than the arc radii on the ulnar aspect (p = 0.001). Different radial and ulnar arcs were observed in 56.25% of the radii; the arc was deeper on the ulnar aspect in 93.75% of the radii.

CONCLUSION

Based on the findings of this study, the likelihood of achieving anatomical reduction with uniformly curved, fixed-angle volar plates is questionable. Changes in the design of these implants may be needed to optimise their usage in the Malaysian Malay population.     

Management of Benign Tracheal Stenosis by Small-diameter Tube-assisted Bronchoscopic Balloon Dilatation

Background:

A limitation of bronchoscopic balloon dilatation (BBD) is that airflow must be completely blocked for as long as possible during the operation. However, the patient often cannot hold his or her breath for a long period affecting the efficacy of the procedure. In this study, we used an extra-small-diameter tube to provide assisted ventilation to patients undergoing BBD and assessed the efficacy and safety of this technique.

Methods:

Bronchoscopic balloon dilatation was performed in 26 patients with benign tracheal stenosis using an extra-small-diameter tube. The tracheal diameter, dyspnea index, blood gas analysis results, and complications were evaluated before and after BBD. Statistical analyses were performed by SPSS version 16.0 for Windows (SPSS, Inc., Chicago, IL, USA).

Results:

Sixty-three BBD procedures were performed in 26 patients. Dyspnea immediately improved in all patients after BBD. The tracheal diameter significantly increased from 5.5 ± 1.5 mm to 13.0 ± 1.3 mm (P < 0.001), and the dyspnea index significantly decreased from 3.4 ± 0.8 to 0.5 ± 0.6 (P < 0.001). There was no significant change in the partial pressure of oxygen during the operation (before, 102.5 ± 27.5 mmHg; during, 96.9 ± 30.4 mmHg; and after, 97.2 ± 21.5 mmHg; P = 0.364), but there was slight temporary retention of carbon dioxide during the operation (before, 43.5 ± 4.2 mmHg; during, 49.4 ± 6.8 mmHg; and after, 40.1 ± 3.9 mmHg; P < 0.001).

Conclusion:

Small-diameter tube-assisted BBD is an effective and safe method for the management of benign tracheal stenosis.