Negative pressure wound therapy as a definitive treatment for upper extremity wound defects: A systematic review

Negative pressure wound therapy (NPWT) represents one of the many solutions for complex wounds of the upper extremity. The goal of this study was to investigate the most common indications for definitive treatment of wound defects in the upper extremity with NPWT and to report revision surgery outcomes after its use. A systematic review of the literature was performed. The following keywords and their combinations were used: “upper extremity,” “arm,” “forearm,” “wrist,” “hand,” “finger” AND “negative‐pressure wound therapy,” “VAC therapy,” “vacuum assisted closure.” A total of 45 articles were included, regrouping 404 cases of NPWT in the upper extremity. The forearm was involved in 53% of cases, followed by hand (36%), fingers (10%), and arm (1%). Seventeen different indications were cited, the most common of which were radial forearm flap reconstruction (23%), burn wounds (18%), and compartment syndromes (17%). Of the cases, 90% did not require any subsequent surgical procedure, as opposed to 6% considered partial failures requiring minor revisions and 4% total failures requiring major revisions. Closure of radial forearm flap donor site required the most revision procedures when treated with NPWT. NPWT can be used for several indications pertaining to the reconstruction of the upper extremity. Positive outcomes as a definitive treatment are demonstrated in this systematic review, which reaffirms NPWT as a potent tool for reconstructive endeavours.     

Characterisation of lettuce virus X, a new potexvirus infecting lettuce in Iran

A virus with flexuous rod-shaped particle morphology was found in samples from lettuce during a survey of viruses infecting lettuce in Tehran province in Iran. This virus was subjected to a complete analysis of its biological and molecular features. The entire nucleotide sequence of the virus was determined, revealing a polyadenylated ssRNA genome consisting of 7,212 nucleotides [without poly (A) tail] and possessing an organization typical for potexviruses. Comparative genome analysis showed that the lettuce virus is closely related to Alstroemeria virus X, narcissus mosaic virus and asparagus virus 3. Based on particle morphology, physico-chemical properties and the complete genome sequence, this virus is a member of a new species in the genus Potexvirus, for which the name lettuce virus X (LeVX) is proposed. Biological assays using an infectious cDNA clone and a wild-type isolate of LeVX revealed that the virus, despite reaching high concentrations in all lettuce cultivars tested, does not cause symptoms in lettuce.     

Epidemiological changes in colorectal cancer in Shiraz, Iran: 1980-2000

BACKGROUND: The present study was performed to determine trends in colorectal cancer rates over the past two decades (1970-80 vs 1990-2000) with in a main referral centre in Shiraz, Iran. METHODS: The Cancer Registry data on all colorectal cancer cases from 1970 to 2000 in Shiraz, Iran, were analysed. Demographic characteristics, clinical features, cancer site and type and stage of cancer were compared in the populations of two different decades. RESULTS: The age-adjusted incidence of colorectal cancer per 100,000 population per year increased in men from a mean annual incidence of 1.61 in the decade 1970-80 to 4.2 in 1990-2000 (P < 0.05), and in women from 2.35 to 2.72 (P < 0.05). In 1970-80, patients over 60 years had 62.5% of all the colorectal cancers, which decreased to 30% in 1990-2000 (P < 0.05). The distribution of right and left sided cancers were almost equal and showed no significant difference between the two decades (P > 0.05). CONCLUSION: A marked increase in the incidence of colorectal cancer has been shown in Shiraz. Also, the marked increase in the incidence of colorectal cancer in the 40-60-year-old age group shown in the present study necessitates a more detailed work-up in younger age group patients.     

Spinal Lesions as Clinical Manifestations of Plasma Cell Neoplasia

(1) Background: Plasma cell neoplasia can be separated into independent subtypes including multiple myeloma (MM) and solitary plasmacytoma of the bone (SBP). The first clinical signs patients present with are skeletal pain, most commonly involving ribs and vertebrae. (2) Methods: Retrospective analysis of 114 patients (38 female, 76 male) receiving spinal surgery from March 2006 until April 2020. Neurological impairments and surgical instability were the criteria for intervention in this cohort. Analysis was based on demographic data, Spinal Instability Neoplastic Score (SINS), location of the lesion, spinal levels of tumor involvement, surgical treatment, histopathological workup, adjuvant therapy, functional outcome, and overall survival (OS). (3) Results: The following surgical procedures were performed: posterior stabilization only in 9 patients, posterior stabilization and decompression without vertebral body replacement in 56 patients, tumor debulking and decompression only in 8 patients, anterior approach in combined approach without vertebral body replacement and without biopsy and/or without kyphoplasty in 33 patients, 3 patients received biopsies only, and 5 patients received kyphoplasty only. The histopathology diagnoses were MM in 94 cases and SBP in 20 cases. Median OS was 72 months (53.4–90.6 months). Preoperative KPSS was 80% (range 40–100%), the postoperative KPSS was 80% (range 50–100%). (4) Conclusions: Surgery for patients with plasma cell neoplasia is beneficial in case of neurological impairment and spinal instability. Moreover, we were able to show that patients with MM and a low number of spinal levels to be supplied have a better prognosis as well as a younger age at the time of the surgical intervention.     

High-frequency spinal cord stimulation in failed back surgery syndrome patients with predominant low back pain—single-center experience

Neurosurgical Review - Treatment of patients with failed back surgery syndrome (FBSS) with predominant low back pain (LBP) remains challenging. High-frequency spinal cord stimulation (HF10 SCS) is...