Successful parathyroidectomy guided by intraoperative parathyroid hormone monitoring for primary hyperparathyroidism is preserved in mild and moderate renal insufficiency

Background

The effect of altered parathyroid hormone metabolism in renal insufficiency on intraoperative parathyroid hormone monitoring during parathyroidectomy is not well known. This study evaluates operative outcomes in patients undergoing parathyroidectomy guided by intraoperative parathyroid hormone monitoring for primary hyperparathyroidism with mild and moderate renal insufficiency.

Liver Transplantation in Recipients With High Model for End-stage Liver Disease Score

Objectives

The score in the Model of End-stage Liver Disease, or MELD, is a good indicator of the survival in patients on the liver transplant waiting list. In this study, an analysis is performed on the benefits of liver transplant on those patients with a very high MELD score and who thus start from a very severe baseline state that could affect the surgical outcome.

Any nonadherence to instructions for use predicts graft-related adverse events in patients undergoing elective endovascular aneurysm repair

Background

A variety of devices exist for endovascular aneurysm repair (EVAR). Device-specific instructions for use (IFU) detail anatomic constraints to application and deployment of devices and are developed from rigorous bench testing. Nonadherence to IFU occurs frequently to avoid open surgery. The purpose of this study was to determine if IFU violations are associated with increased risk of graft-related adverse events (GRAEs) during follow-up.

Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis

Objective

We evaluated images of patients undergoing a thoracic endovascular aortic repair procedure using two reference points as a means for differentiating stent graft migration from aortic elongation. Conventional standards define migration of a stent graft as an absolute change in the distance from the distal graft ring to a distal landmark ≥10 mm compared with a baseline measurement. Aortic elongation occurs over time in both healthy individuals and patients with aortic disease. Aortic elongation in patients with stent grafts may result in increased distal thoracic aortic lengths over time. False-positive stent graft migration would be defined when these patients meet the standard definition for migration, even if the stent has not moved in relation to the elongating aorta.

Calcaneal Avulsion of an Ochronotic Achilles Tendon: A Case Report

Alkaptonuria is a hereditary disorder of phenylalanine and tyrosine, with an incidence of approximately 1/200,000 to 1/1,000,000. Ochronosis is the accumulation of homogentisic acid and its metabolites in connective tissues such as the tendons, cartilage, and skin. In the present case study, a 50-year-old male presented with a nontraumatic calcaneal avulsion without a previous diagnosis of ochronosis. To the best of our knowledge, little information has been reported of this pathology in the Achilles tendon and the surgical management.     

Large Osseous Defect Reconstruction Using a Custom Three-Dimensional Printed Titanium Truss Implant

Treatment of large osseous defects remains a difficult surgical challenge. Autografts and allografts have been known to undergo late collapse, because these options are not specifically designed to withstand the high loads of the foot and ankle. The inability to achieve the correct shape for reconstruction further limits their application. Large osseous defects will result during salvage after failed Lapidus bunionectomy, explantation of failed total ankle replacements, and nonunion of Evans calcaneal osteotomy. Each of 3 patients received a 4WEB custom 3-dimensional (3D) titanium truss implant (Patient Specific Custom Implant; 4WEB Medical, Inc., Frisco, TX) for reconstruction. The mean follow-up period was 17.33?±?3.51 months. Significant improvement was seen in pain, with a successful return to activities of daily living. The 12-month postoperative computed tomography findings demonstrated incorporation of the implant to the surrounding cortical and cancellous bone. No signs of delayed complications, such as stress shielding or implant failure, were found. This is the first case series to describe the use of a custom 3D-printed titanium truss implant to successfully contribute to reconstruction in the setting of failed elective foot and ankle surgery. This technology might play an important role in limb salvage of osseous defects that would otherwise require bone block arthrodesis with structural allograft or autograft bone.     

Defining Talar Head and Neck Pathology: The Malvern Classification System

Talar fractures account for <1% of all fractures in the body and 3% to 6% of pedal fractures. Of these fractures, avulsion and neck fractures represent the most and second most common type, respectively. Several classification systems exist for talar fractures of the talar dome (Berndt-Hardy), talar neck dislocation (Hawkins), and talar body (Sneppen) anatomic locations. Although diverse, they are not all encompassing for fracture patterns of the talus. Another set of pathologic issues occur about the talar head and neck region that can be seen in the clinical setting. Thus, a new classification system (Malvern classification system for talar head/neck fractures) was devised and defined for this location. The system represents a comprehensive review of the available published data and synthesis into an organized classification system.