Incidence and predictive risk factors of postoperative sepsis in orthopedic trauma patients

Background

Postoperative sepsis is associated with high mortality and the national costs of septicemia exceed those of any other diagnosis. While numerous studies in the basic orthopedic science literature suggest that traumatic injuries facilitate the development of sepsis, it is currently unclear whether orthopedic trauma patients are at increased risk. The purpose of this study was thus to assess the incidence of sepsis and determine the risk factors that significantly predicted septicemia following orthopedic trauma surgery.

Materials and methods

56,336 orthopedic trauma patients treated between 2006 and 2013 were identified in the ACS-NSQIP database. Documentation of postoperative sepsis/septic shock, demographics, surgical variables, and preoperative comorbidities was collected. Chi-squared analyses were used to assess differences in the rates of sepsis between trauma and nontrauma groups. Binary multivariable regressions identified risk factors that significantly predicted the development of postoperative septicemia in orthopedic trauma patients.

Results

There was a significant difference in the overall rates of both sepsis and septic shock between orthopedic trauma (1.6%) and nontrauma (0.5%) patients (p < 0.001). For orthopedic trauma patients, ventilator use (OR = 15.1, p = 0.002), history of pain at rest (OR = 2.8, p = 0.036), and prior sepsis (OR = 2.6, p < 0.001) were significantly associated with septicemia. Statistically predictive, modifiable comorbidities included hypertension (OR = 2.1, p = 0.003) and the use of corticosteroids (OR = 2.1, p = 0.016).

Conclusions

There is a significantly greater incidence of postoperative sepsis in the trauma cohort. Clinicians should be aware of these predictive characteristics, may seek to counsel at-risk patients, and should consider addressing modifiable risk factors such as hypertension and corticosteroid use preoperatively. Level of evidence Level III.

     

Acute kidney injury after open ventral hernia repair: an analysis of the 2005–2012 ACS-NSQIP datasets

Purpose

Acute kidney injury (AKI) is a serious postoperative complication, negatively impacting mortality rates, extending length of stay, and raising hospital costs. The purpose of this study was to examine AKI following open ventral hernia repair (OVHR) using a large, heterogeneous database to determine the incidence and identify risk factors for this complication.

Methods

Using the 2005–2012 ACS-NSQIP database, patients undergoing open ventral hernia repair were identified by CPT codes. Patients with acute kidney injury within 30 days of surgery were compared to controls by multivariate logistic regression across preoperative and intraoperative characteristics.

Results

Of 48,629 open ventral hernia repair patients identified in the dataset, AKI developed in 1.4 % (681 patients). Multivariate logistic regression determined a number of factors associated with AKI. These include WHO Class III obesity (OR = 2.57, p < 0.001), history of cardiovascular disease (OR = 1.81, p < 0.001), diabetes (OR = 1.29, p = 0.028), hypoalbuminemia (OR = 1.42, p = 0.004), and chronic kidney disease (for a baseline GFR of 60?89 mL/min/1.73m2, OR = 1.62, p = 0.001; for 30?59 mL/min/1.73m2, OR = 2.25, p < 0.001; for 15?29 mL/min/1.73m2, OR = 4.96, p < 0.001). Intraoperative factors include prolonged operative time (for ≥1SD above the mean, OR = 1.68, p = 0.002; for ≥2SD above the mean, OR = 2.76, p < 0.001) and intraoperative transfusion (OR = 2.44, p < 0.001).

Conclusions

Patients with a history of obesity, chronic kidney disease, cardiovascular history, diabetes, and hypoalbuminemia are at increased risk for AKI when undergoing OVHR. Intraoperative variables such as prolonged operative times and blood transfusions may also suggest increased risk. Preoperative identification of patients with these characteristics and perioperative hemodynamic stabilization are important first steps to minimize this complication.

     

Association between IGF1 gene single nucleotide polymorphism (rs5742612) and adolescent idiopathic scoliosis: a meta-analysis

Purpose

Insulin-like growth factor 1 (IGF1) gene single nucleotide polymorphism (rs5742612) has been associated with adolescent idiopathic scoliosis (AIS) in several studies with limited sample size and inconsistent outcomes. So we perform this meta-analysis to assess the precise association between IGF1 gene single nucleotide polymorphism (rs5742612) and AIS.

Methods

We systematically searched Pubmed, Embase, Web of Science and Cochrane Library up to January 19, 2016 to obtain relevant studies using our research strategy. Four articles all belonging to case–control studies were included in our meta-analysis.

Results

A total of four studies containing 763 cases and 559 controls satisfied the inclusion criteria after judgment by two reviewers. No significant associations were detected between IGF1 gene single nucleotide polymorphism (rs5742612) and AIS (T vs. C, OR = 1.10, 95 % CI 0.91–1.34, p = 0.32; TT vs. CC: OR = 1.28, 95 % CI 0.82–2.02, p = 0.28; TC vs. CC: OR = 1.29, 95 % CI 0.82–2.06, p = 0.27; TT/TC vs. CC: OR = 1.28, 95 % CI 0.83–1.98, p = 0.27; TT vs. TC/CC: OR = 1.06, 95 % CI 0.82–1.36, p = 0.66).

Conclusions

IGF1 gene single nucleotide polymorphism (rs5742612) is not significant associated with susceptibility to AIS in either Asian or Caucasian populations. However, IGF1 gene rs5742612 may be associated with severity of AIS. Further studies with larger sample size and different population groups involving the relationship are required to confirm the potential association.

     

Risk Factors for Mortality and Morbidity in Elderly Patients Presenting with Digestive Surgical Emergencies

Background

Emergency digestive surgery is being increasingly performed in elderly patients. The aim of the present study was to identify the predictors of mortality and morbidity following emergency digestive surgery in patients aged 80 years and older.

Methods

A single-center retrospective review was performed of consecutive patients aged ≥65 years operated for a digestive surgical emergency between January 2011 and December 2013. Two groups were compared: group A (aged 65–79 years) and group B (aged ≥80 years).

Results

The study population included 185 patients: 76 patients in group A and 109 in group B. The mean age was 79.9 years (65–104 years). The overall 90-day mortality rate was 23.2 and 31.9% at 1 year, which was similar between groups. The overall morbidity was 28.6%. No differences were noted between the two groups in overall, minor (Dindo I–II) or major (Dindo III–IV) morbidity rates. Multivariate analysis identified pulmonary disease (odds ratio, OR = 6.43, p = 0.02), bowel ischemia (OR = 11.41, p = 0.01), postoperative ICU stay (OR = 7.37, p < 0.0001) and the occurrence of postoperative complications (OR = 2.66, p = 0.03) as predictors of 90-day mortality. Predictors of in-hospital morbidity were preoperative hemoglobin <12 g/dL (OR = 2.49, p = 0.02) and postoperative intensive care unit (ICU) stay (OR = 6.69, p < 0.0001). An age ≥80 year was not associated with mortality or morbidity in this study.

Conclusions

The decision to perform abdominal surgery in the emergency setting should be based on physiological status, which accounts for a patient’s comorbidities and health status, rather than on chronological age per se.

     

Image-based monitoring of targeted biopsy-proven prostate cancer on active surveillance: 11-year experience

Purpose

To report our 11-year experience of Active Surveillance (AS) program focusing on modern transrectal ultrasound (TRUS)-based monitoring of targeted biopsy-proven cancer lesion.

Methods

Consecutive patients on AS, who had targeted biopsy-proven lesion followed by at least a repeat surveillance biopsy and three times TRUS monitoring of the identical visible lesion, were included. Doppler grade of blood flow signal within the lesion was classified from grade 0 to 3. Biopsy-proven progression was defined as upgrade of Gleason score or 25 % or greater increase in cancer core involvement.

Results

Fifty patients were included in this study. Clinical variables (median) included age (61 years), clinical stage (T1c, 42;T2, 8), PSA (4.6 ng/ml), and Gleason score (3 + 3, n = 41;3 + 4, n = 9). Of the 50 patients, 34 demonstrated pathological progression at a median follow-up of 4.4 years. In comparing between without (n = 16) and with (n = 34) pathological progression, there were significant differences in cancer core involvement at entry (p = 0.003), the major axis diameter (p = 0.001) and minor axis diameter (p = 0.001) of the visible lesion at entry, increase in the major axis diameter (p = 0.005) and minor axis diameter (p = 0.013), and upgrade of Doppler grade (p < 0.0001). In multivariate analysis for predicting pathological progression, the increase (≥25 %) in diameter of biopsy-proven lesion (hazard ratio, 15.314; p = 0.023) and upgrade of Doppler grade (hazard ratio, 37.409; p = 0.019) were significant risk factors.

Conclusions

Longitudinal monitoring of the TRUS-visible biopsy-proven cancer provides a new opportunity to perform per-lesion-based AS. The increase in diameter and upgrade of Doppler grade of the lesion were significant risk factors for biopsy-proven progression on AS.

     

The association between interleukin-28B gene polymorphisms as a potential biomarker and the risk of chronic Periodontitis in an Iranian population

Background

Chronic Periodontitis (CP) is a common inflammatory disease affects supporting tissues of the teeth and can lead to tooth loss. The objective of this study was to determine the relationship between polymorphisms in the IL-28B gene and chronic periodontitis in an Iranian population.

Methods

Two hundred and ten CP patients and one hundred healthy subjects were enrolled in the present case-control study. The rs12979860 and rs8099917 SNPs were identified using RFLP and T-ARMS-PCR methods respectively.

Results

SNP analysis revealed that the G allele of rs8099917 SNP and T allele of rs12979860 SNP increased susceptibility to CP compared to the A allele and C allele (p < 0.0001, OR = 2.712, CI = 1.783-4.126; p < 0.0001, OR = 2.538, CI = 1.784-3.613 respectively). In addition, the CT/GT, TT/GG and TT/GT haplotypes were predominant in CP patients and significantly associated with the increased risk of CP.

Conclusion

IL-28B polymorphisms may be useful predictive factors for chronic periodontitis and correlated to the susceptibility to CP infection in our population.

     

Anterior shoulder stabilization by Bristow–Latarjet procedure in athletes: return-to-sport and functional outcomes at minimum 2-year follow-up

Purpose

The aim of this study was to assess return-to-sport outcomes following the Latarjet–Bristow procedure.

Methods

This retrospective study included all athletes <50 years old, who underwent a Latarjet–Bristow procedure for anterior shoulder instability in 2009–2012. Main criteria assessments were the number of athletes returning to any sport and the number returning to the same sport at their preinjury level. The main follow-up was 46.8 ± 9.7 months.

Results

Forty-seven patients were analyzed, 46 men/1 women, mean age 27.9 ± 7.9 years. Eighteen patients practiced competitive sports and 29 recreational sports. None of them were professional athletes. One hundred percent returned to sports after a mean 6.3 ± 4.3 months. Thirty/47 (63.8 %) patients returned to the same sport at the same level at least and 10/47 (21.3 %) patients changed sport because of their shoulder. Compared to patients who returned to the same sport at the same level, patients who changed sports or returned to a lower level had practiced overhead or forced overhead sports [OR = 4.7 (1.3–16.9), p = 0.02] before surgery, experienced avoidance behavior at the final follow-up (p = 0.002), apprehension (p = 0.00001) and had a worse Western Ontario Shoulder Instability Index score and sub-items (p = 0.003) except for daily activities (p = 0.21). At the final follow-up, 45/47 (95.7 %) patients were still practicing a sport.

Conclusion

All the patients returned to sports, most to their preinjury sport at the same level. Patients who practiced an overhead sport were more likely to play at a lower level or to change sport postoperatively.

Level of evidence

IV, retrospective study—Case series with no comparison group.

     

Usefulness of Inflammation-Based Prognostic Score in Patients Undergoing Lung Metastasectomy for Colorectal Carcinoma

Objectives

There is increasing evidence that Glasgow Prognostic Score (GPS), based on systemic inflammatory response and albumin level, is a useful predictor of overall survival in patients with various types of cancer.

Methods

Patients with lung metastasis from colorectal carcinoma who underwent a lung metastasectomy from 2000 to 2015 were retrospectively investigated. Routine laboratory measurements including serum C-reactive protein (CRP), albumin, and the tumor marker carcinoembryonic antigen were performed before the metastasectomy.

Results

Ninety-nine patients underwent 132 lung metastasectomy procedures during the study period. Kaplan–Meier analysis revealed that GPS (p = 0.017), number of metastases (p = 0.004), and the presence of liver metastasis (p = 0.010) were associated with overall survival, while univariate analysis selected GPS (p = 0.028), number of metastases (p = 0.005), and liver metastasis (p = 0.014) as predictive factors associated with overall survival. Multivariate analysis also indicated GPS (p = 0.004), number of metastases (p = 0.004), and liver metastasis (p = 0.013) as predictive factors associated with overall survival.

Conclusion

In addition to number of metastases and liver metastasis, GPS is an important predictor of overall survival in colorectal cancer patients who undergo a lung metastasectomy.

     

Feasibility of the liver-first approach for patients with initially unresectable and not optimally resectable synchronous colorectal liver metastases

Purpose

To investigate the outcomes of patients with colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated using the liver-first approach in the era of modern chemotherapy in Japan.

Methods

We analyzed and compared data retrospectively on patients with asymptomatic resectable colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated either using the liver-first approach (n = 12, LF group) or the primary-first approach (n = 13, PF group).

Results

Both groups of patients completed their therapeutic plan and there was no mortality. Postoperative morbidity rates after primary resection and hepatectomy, and post-hepatectomy liver failure rate were comparable between the groups (p = 1.00, p = 0.91, and p = 0.55, respectively). Recurrence rates, median recurrence-free survival since the last operation, and 3-year overall survival rates from diagnosis were also comparable between the LF and PF groups (58.3 vs. 61.5 %, p = 0.87; 10.5 vs. 18.6 months, p = 0.57; and 87.5 vs. 82.5 %, p = 0.46, respectively).

Conclusions

The liver-first approach may be an appropriate treatment sequence without adversely affecting perioperative or survival outcomes for selected patients.

     

Risk Factors for Early Recurrence of Single Lesion Hepatocellular Carcinoma After Curative Resection

Background and objectives

Hepatic resection is established as the treatment for HCC. However, patients sometimes experience early recurrence of HCC (ER HCC) after curative resection.

Methods

A retrospective analysis was conducted for 193 patients with single HCC who underwent curative liver resection in our medical center between April 2000 and March 2013. We divided the cohort into two groups; early recurrence group (ER G) which experienced recurrence within 6 months after resection, and non-early recurrence group (NER G). Risk factors for ER HCC were analyzed.

Results

Thirty-nine out of 193 (20.2 %) patients had ER HCC. Univariate analysis showed Glasgow prognostic score (GPS, p = 0.036), neutrophil to lymphocyte ratio (NLR, p = 0.001), level of PIVKA-II (p = 0.0001), level of AFP (p = 0.0001), amounts of blood loss (p = 0.001), operating time (p = 0.002), tumor size (p = 0.0001), stage III and IV (p = 0.0001), and microvascular invasions (portal vein: p = 0.0001 and hepatic vein: p = 0.001) to be associated with ER HCC. By multivariate analysis, there were significant differences in high NLR (p = 0.029) and high AFP (p = 0.0001) in patients with ER HCC.

Conclusions

Preoperative high AFP (more than 250 ng/ml) and high NLR (more than 1.829) were independent risk factors for ER HCC.

     

The impact on the prognosis of unsuspected N2 disease in non-small-cell lung cancer: indications for thorough mediastinal staging in the modern era

Purpose

Predicting the prognosis of advanced non-small-cell lung cancer (NSCLC) patients who present with clinically unsuspected N2 is very different due to the heterogeneity of this cohort. Thus, this study was undertaken to identify the clinicopathological features and survival of patients with clinical N0 or N1 and pathological N2, namely, unsuspected N2.

Methods

Among 239 patients with pathological N2 NSCLC, we reviewed the cases of 92 (38.5 %) patients who showed unsuspected N2. The prognosis was investigated using the Kaplan–Meier method and a Cox regression model.

Results

The 5-year overall survival (5yOS) of the patients with unsuspected N2 was 51.2 %. Based on a multivariate analysis, age and 18F-fluorodeoxyglucose (FDG) uptake in the lymph nodes were significant prognostic factors of unsuspected N2 (p = 0.0081, 0.0228, respectively). The 5yOS of PET-negative unsuspected N2 (n = 68) was 58.9 %, whereas that of PET-positive unsuspected N2 (n = 24) was 29.7 % (p = 0.0026). Furthermore, the 5yOS of PET-negative unsuspected N2 was significantly better than that of both clinical and pathological N2 s (i.e., suspected N2; n = 60; 5yOS, 42.1 %; p = 0.0051), while no significant difference was observed between PET-positive unsuspected N2 and suspected N2 (p = 0.6325).

Conclusions

A preoperative evaluation of the lymph nodes by PET/CT has a potential benefit in predicting the prognosis. A thorough evaluation of the lymph nodes is, therefore, needed if the lymph nodes show an FDG uptake, even in cases that show a clinical N0 status on thin section CT scans.

     

Better Late than Never? Adherence to Adjuvant Therapy Guidelines for Stage III Colon Cancer in an Underserved Region

Introduction

In 2008, the American College of Surgeons Commission on Cancer (CoC) issued a quality guideline for stage III colon cancer (CC) recommending adjuvant chemotherapy (AC) within 120 days of diagnosis. We examined adherence in a healthcare system serving a region with disparities in CC outcomes.

Methods

In a retrospective analysis of patients (2005–2014) with stage III CC in a multi-hospital healthcare system, the associations between adherence, clinicopathologic, demographic, geographic, and socioeconomic data and overall survival (OS) were examined.

Results

Of 1171 CC patients, 438 (37.4%) had stage III disease with 63% (n = 276) receiving AC and 37% (n = 162) not. AC conferred a 5-year OS advantage (62.4 vs. 42.5%, p < 0.0001). Younger age independently predicted AC receipt (OR = 0.95, p < 0.0001). Of 252 AC patients < 80 years, 75.8% were CoC guideline compliant (GC) whereas 24.2% were not (nGC). Although there was no OS difference between GC and nGC, both had superior survival (p < 0.0001) compared to non-AC patients. Surgical complications trended towards independent association with non-compliance (p = 0.07)

Conclusion

Guideline compliance in our system (63%) is lower than the CoC Estimated Performance Rate (72.4%). Age influenced absolute receipt of AC while surgical complications may impact guideline compliance. Even when administered beyond 120 days, AC was associated with a survival benefit.

     

Desarda’s technique versus Lichtenstein technique for the treatment of primary inguinal hernia: a systematic review and meta-analysis of randomized controlled trials

Purpose

The Lichtenstein technique (LT) has been recognized as the standard treatment for inguinal hernia in adults owing to the high recurrence rates of tissue-based repairs. However, Desarda technique (DT) appeared as promising tissue-based repair that provided low incidence of recurrence without the need for implanting prosthetic or foreign materials in the inguinal canal. This meta-analysis of randomized controlled trials (RCTs) comparing DT and LT for primary inguinal hernia in adults aimed to determine which technique had better clinical outcome regarding recurrence and complication rates.

Methods

A systematic literature search for RCTs comparing between DT and LT was conducted using electronic databases and Google scholar service. Patients’ characteristics, technical details, recurrence and complication rates, and time to resume daily activities were extracted from the original studies and analyzed.

Results

Six RCTs comprising 2159 patients (89% males) were included. No significant difference in the incidence of recurrence between both techniques was detected (OR = 0.946; P = 0.91). The overall complication rate of LT was significantly higher than DT (OR = 1.86; P < 0.001). LT had significantly higher rates of seroma formation and surgical site infection (OR = 2.17; P = 0.007) and (OR = 2.17; P = 0.029), respectively. Postoperative pain, operation time, and time to resume normal activities were comparable in both groups.

Conclusion

Both DT and LT provided satisfactory treatment for primary inguinal hernia with low recurrence rates and acceptable rates of complications that were significantly less after DT. More well-designed RCTs with longer follow-up are required for further validation of the DT.

     

A cohort study of the morbidity of combined anterior-posterior cervical spinal fusions: incidence and predictors of postoperative dysphagia

Purpose

To identify risk factors that may lead to the development of dysphagia after combined anterior and posterior (360°) cervical fusion surgery.

Methods

A single center, retrospective analysis of patients who had same-day, 360° fusion at Henry Ford Hospital between 2008 and 2012 was performed. Variables analyzed included demographics, medical co-morbidities, levels fused, and degree of dysphagia.

Results

The overall dysphagia rate was 37.7 %. Patients with dysphagia had a longer mean length of stay (p < 0.001), longer mean operative time (p < 0.001), greater intraoperative blood loss (p = 0.002), and fusion above the fourth cervical vertebra, C4, (p = 0.007). There were no differences in the rates of dysphagia when comparing patients undergoing primary or revision surgery (p = 0.554).

Conclusion

Prolonged surgery and fusion above C4 lead to higher rates of dysphagia after 360° fusions. Prior anterior cervical fusion does not increase the risk of dysphagia development.

     

Increased apical rotation in patients with severe aortic stenosis assessed by three-dimensional speckle tracking imaging

Background

Two-dimensional (2D) speckle tracking imaging (STI) is a non-invasive method used to assess subtle changes in left ventricular (LV) function such as strain and rotational dynamics. However, 2D methodology is complicated by issues such as the out-of-plane problem inherent in short-axis imaging. In addition, circumferential rotation contributes to three-dimensional (3D) wall deformations and affects tracking accuracy. By using 3D-STI technique, we evaluated LV global longitudinal strain (GLS) and apical rotation in severe aortic stenosis (AS) patients with preserved LV ejection fraction (EF).

Methods

LV GLS and apical rotation were evaluated using 3D-STI in 20 severe AS patients (79 ± 8 years old; aortic valve area 0.7 ± 0.2 cm²) with preserved LVEF (68 ± 7%). Data were compared with those of 11 hypertensive LV hypertrophy (LVH) patients (75 ± 10 years old, EF = 66 ± 4%) and 12 controls (healthy individuals: 30 ± 14 years old, EF = 63 ± 6%).

Results

Compared with LVH patients, severe AS patients had significantly decreased values of GLS (?13.0 ± 2.4 vs. ?10.4 ± 2.0%, p = 0.008). In contrast, LV rotation was significantly higher in AS than LVH patients (13.9 ± 3.0° vs. 10.8 ± 2.5°, p = 0.007). There was no significant difference in stroke volume index among three groups. In these three groups, severe AS patients had significantly decreased values of GLS [analysis of variance (ANOVA), p < 0.001] and increased LV rotation (ANOVA, p < 0.001).

Conclusions

In severe AS patients, impaired GLS existed although LVEF was preserved. However, LV rotation was increased in patients with severe AS probably to maintain the LV stroke volume.

     

A multi-institutional,propensity-score-matched comparison of post-operative outcomes between general anesthesia and monitored anesthesia care with intravenous sedation in umbilical hernia repair

Purpose

Monitored anesthesia care with intravenous sedation (MAC/IV), recently proposed as a good choice for hernia repair, has faster recovery and better patient satisfaction than general anesthesia; however the possibility of oversedation and respiratory distress is a widespread concern. There is a paucity of the literature examining umbilical hernia repairs (UHR) and optimal anesthesia choice, despite its importance in determining clinical outcomes.

Methods

A retrospective analysis of anesthesia type in UHR was performed in the National Surgical Quality Improvement Program 2005–2013 database. General anesthesia and MAC/IV groups were propensity-score-matched (PSM) to reduce treatment selection bias. Surgical complications, medical complications, and post-operative hospital stays exceeding 1 day were the primary outcomes of interest. Pre-operative characteristics and post-operative outcomes were compared between the two anesthesia groups using univariate and multivariate statistics.

Results

PSM removed all observed differences between the two groups (p > 0.05 for all tracked pre-operative characteristics). MAC/IV cases required fewer post-operative hospital stays exceeding 1 day (3.5 vs 6.3 %, p < 0.001). Univariate analysis showed that overall complication rate did not differ (1.7 vs 1.8 %, p = 0.569), however MAC/IV cases resulted in fewer incidences of septic shock (<0.1 vs 0.1 %, p = 0.016). After multivariate logistic regression, MAC/IV was revealed to yield significantly lower chances of overall medical complications (OR = 0.654, p = 0.046).

Conclusion and relevance

UHR under MAC/IV causes fewer medical complications and reduces post-operative hospital stays compared to general anesthesia. The implications for surgeons and patients are broad, including improved surgical safety, cost-effective care, and patient satisfaction.

     

Comparative study of high tibial osteotomy using dynamic axial fixator and locked low-profile plate in medial osteoarthritis of knee

Purpose

The purpose of this study was to evaluate the role of medial opening wedge high tibial osteotomy (HTO) in medial unicompartmental osteoarthritis (MCOA) of knee and to compare between the two methods of osteotomy using either dynamic axial fixator (DAF) or locking compression plate (LCP).

Methods

A total of 20 patients with medial osteoarthritis of knee were enrolled in this prospective study who were divided into two groups of 10 each. First group comprising of two males and eight females were treated by HTO using DAF. Second group comprising of five males and five females were treated by HTO using LCP. We assessed various radiological parameters including hip knee ankle angle (HKA), tibiofemoral angle (TFA), weight-bearing line on tibia, Insall Salvati index and tibial slope. Functional outcome of knee at final follow-up was assessed by Oxford knee score (OKS) and visual analogue scale.

Results

In first group, mean HKA angle changed from 187° to 178.30° (p = 0.006), mean TFA from 182.40° to 172° (p = 0.003), average position of weight-bearing line from 11.24 to 59.54 % (p = 0.004), and mean OKS 43.3–16.9 (p = 0.004). In second group, mean HKA angle changed from 186° to 178.80° (p = 0.004), mean TFA from 180.90° to 173.60° (p = 0.004), average position of weight-bearing line from 14 to 61.3 % (p = 0.004), and mean OKS 43.2–16.5 (p = 0.002).

Conclusion

HTO is an established treatment for patients with symptomatic MCOA knee with significant improvement in the clinical and radiographic parameters. There is no significant difference between the two methods; however, external fixator has the complication of pin tract infections.

Level of evidence

II.

     

Robotic or laparoscopic sacrohysteropexy versus open sacrohysteropexy for uterus preservation in pelvic organ prolapse

Introduction and hypothesis

The aim of this study was to compare robotic or laparoscopic sacrohysteropexy (RLSH) and open sacrohysteropexy (OSH) as a surgical treatment for pelvic organ prolapse (POP).

Methods

Among 111 consecutive patients who had undergone sacrohysteropexy for POP, surgical outcomes and postoperative symptoms were compared between the RLSH (n?=?54; robotic 14 cases and laparoscopic 40 cases) and OSH (n?=?57). groups The medical records of enrolled patients were reviewed retrospectively.

Results

Compared with the OSH group, the RLSH group had shorter operating time (120.2 vs 187.5 min, p?<?0.0001), less operative bleeding (median estimated blood loss 50 vs 150 ml; p?<?0.0001; mean hemoglobin drop 1.4 vs 2.0 g/dl; p?<?0.0001), and fewer postoperative symptoms (13 vs 45.6 %; p?<?0.0001). Patients’ overall satisfaction (94.4 vs 91.2 %; p?=?0.717) and required reoperation due to postoperative complications (3.7 vs 1.8 %; p?=?0.611) did not differ between groups.

Conclusions

RLSH could be a feasible and safe procedure in patients with POP and should be considered as a surgical option that allows preservation of the uterus. Prospective randomized trials will permit the evaluation of potential benefits of RLSH as a minimally invasive surgical approach.

     

The distribution of infection with <Emphasis Type="Italic">Propionibacterium acnes</Emphasis> is equal in patients with cervical and lumbar disc herniation

Background

Cervical and back pains are important clinical problems affecting human populations globally. It is suggested that Propionibacterium acnes (P. acnes) is associated with disc herniation. The aim of this study is to evaluate the distribution of P. acnes infection in the cervical and lumbar disc material obtained from patients with disc herniation.

Methods and material

A total of 145 patients with mean age of 45.21 ± 11.24 years who underwent micro-discectomy in cervical and lumbar regions were enrolled into the study. The samples were excited during the operation and then cultured in the anaerobic incubations. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction.

Results

In this study, 145 patients including 25 cases with cervical and 120 cases with lumbar disc herniation were enrolled to the study. There was no significant difference in the age of male and female patients (p = 0.123). P. acnes infection was detected in nine patients (36%) with cervical disc herniation and 46 patients (38.3%) with lumbar disc herniation and no significant differences were reported in P. acnes presence according to the disc regions (p = 0.508.). Moreover, there was a significant difference in the presence of P. acnes infection according to the level of lumbar disc herniation (p = 0.028).

Conclusion

According to the results, the presence of P. acnes is equal in patients with cervical and lumbar disc herniation. There was a significant difference in the distribution of P. acnes infection according to level of lumbar disc herniation.

Level of Evidence

II