scholarly journals Osteolysis following PE Wear of a Hastings Head on a Monoblock Hip Stem

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Sarah Fischer ◽  
Valerie Polster ◽  
Miriam Ruhr ◽  
Robert Hube ◽  
Michael M. Morlock
Keyword(s):  
Index Operation

We report a case of extended osteolysis, requiring a third revision of the left hip in an 85-year-old man 46 years after index operation. Major polyethylene (PE) wear occurred due to a missmatched combination of a bipolar Hastings head with a PE liner and head damage of the originally maintained stem. This case demonstrates that bipolar heads should not be used with PE cup liners since the respective bearing diameters cannot be guaranteed to match due to missing specifications. Furthermore, putting a Hastings head on an already damaged head of the stem should be omitted and rather the stem should initially be revised.

scholarly journals Prophylactic mesh placement of permanent stomas at index operation for colorectal cancer

2012 ◽  
Vol 94 (8) ◽  
pp. 569-573 ◽  
Author(s):  
NT Ventham ◽  
RR Brady ◽  
RG Stewart ◽  
BM Ward ◽  
C Graham ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Abdominal Wall ◽  
Parastomal Hernia ◽  
Abdominal Wall Defect ◽  
Prophylactic Mesh ◽  
Permanent Colostomy ◽  
Wall Defect ◽  
Mesh Placement ◽  
Clinical Endpoints ◽  
Index Operation

INTRODUCTION Parastomal herniation occurs in 30–50% of colostomy formations. The aim of this study was to radiologically evaluate the mechanical defects at stoma sites in patients who had previously undergone a permanent colostomy with or without mesh at the index operation for colorectal cancer. METHODS A study was performed of all colorectal cancer patients (n=41) having an end colostomy between 2002 and 2010, with or without Prolene® mesh plication, with blinded evaluation of the annual follow-up staging computed tomography (CT) for stomal characteristics. The presence of parastomal hernias, volume, dimensions, grade of the parastomal hernia and abdominal wall defect size were measured by two independent radiologists, and compared with demographic and operative variables. RESULTS In those patients with radiological evidence of a parastomal hernia, Prolene® mesh plication significantly reduced the incidence of bowel containing parastomal hernias at one year following the procedure (p<0.05) and also reduced the diameter of the abdominal wall defect (p=0.006). CONCLUSIONS Prophylactic mesh placement at the time of the index procedure reduces the diameter of abdominal wall aperture and the incidence of parastomal hernias containing bowel. Future studies should use both objective radiological as well as clinical endpoints when assessing parastomal hernia development with and without prophylactic mesh.

Prediction for a planned relaparotomy in secondary peritonitis

Open Medicine ◽  
2013 ◽  
Vol 8 (4) ◽  
pp. 410-414
Author(s):  
A. Sileikis ◽  
D. Kazanavicius ◽  
A. Skrebunas ◽  
A. Ostapenko ◽  
K. Strupas
Keyword(s):  
Scoring System ◽  
Multivariate Regression Analysis ◽  
Secondary Peritonitis ◽  
Reactive Protein ◽  
Index Operation ◽  
Significant Difference ◽  
Group A ◽  
Risk Scoring ◽  
Group B ◽  
Planned Relaparotomy

AbstractAims. To devise a scoring system for clinical variables related to positive findings at relaparotomy in secondary peritonitis. Methods. We have retrospectively studied 195 cases of patients after relaparotomy. According to the operation’s findings, the patients were divided into two groups: ‘relaparatomy unnecessary’ group A, ‘relaparotomy necessary’ group B. 6 factors (age, sex, leukocyte count, C reactive protein, time of symptoms to index operation, Mannheim Peritonitis Index) were evaluated in respect to their significance in decision making for relaparotomy. The predictive value for positive operation`s findings of these factors was evaluated by logistic multivariate regression analysis. According to this model a risk scoring system was created to support the decision whether to perform a relaparotomy. Results. Relaparotomy was unnecessary (Group A) for 154 (79,0%) patients, for 41 (21,0%) it was necessary (Group B). Comparing the groups A and B, we found a significant difference in patients’ mean age (54 v. 63 years, p=0,002), mean CRP level (133,2 v. 182,8 mg/L, p=0,025), mean time of symptoms to index operation (38,1 v. 67,1 hours, p=0,006) and mean MPI value (22,4 v. 29,4, p<0,0001). According to the above-mentioned predictors, a scoring system was devised: −0,17-(0,003×patient’s age years)+(0.153×time of symptoms to index operation hours)-(0,297×MPI)+(0,192×CRP mg/l). The score was 24,798±25,593 in group A and 36,572±32,543 in group B(p=0,028). Conclusions: Scoring system was devised to assist in creating treatment strategy after secondary peritonitis. If the score is ≥37, a planned relaparotomy should be performed. If the score is ≤24, other diagnostic and therapeutic tactics should be applied.

Ventricular entry during resection of malignant gliomas: effect on intracranial cerebrospinal fluid tumor dissemination

1994 ◽  
Vol 80 (5) ◽  
pp. 834-839 ◽  
Author(s):  
J. Paul Elliott ◽  
G. Evren Keles ◽  
Michael Waite ◽  
Nancy Temkin ◽  
Mitchel S. Berger
Keyword(s):  
Cerebrospinal Fluid ◽  
Survival Rate ◽  
Ventricular System ◽  
University Of Washington ◽  
Content Type ◽  
Index Operation ◽  
System P ◽  
Tumor Dissemination ◽  
The University ◽  
Fine Print

✓ The ventricular system is not infrequently entered during the course of maximum cytoreductive surgery for high-grade supratentorial gliomas. It is unclear if ventricular entry during surgery and/or proximity of the tumor to the ventricular system affects cerebrospinal fluid (CSF) tumor dissemination or the patients' overall survival rate. The authors retrospectively reviewed hospital records and neuroradiological studies of 51 patients operated on at the University of Washington between 1987 and 1991. Inclusion in this study necessitated a pathological diagnosis of malignant glioma and the availability of preoperative and postoperative computerized tomography scans or magnetic resonance images. Patients were excluded from the study if they had radiographic evidence of ventricular entry or CSF tumor dissemination prior to referral to the authors' institution. The index operation was defined as the first operation at the University of Washington or (in those patients with ventricular entry) the operation in which the ventricle was entered. Patients were followed until time of death or, in the case of survivors, until February, 1992. The effect of both ventricular entry and the proximity of the tumor to the ventricular system on CSF tumor dissemination and survival rate was assessed using statistical survival methodology. There was no significant difference in time from diagnosis to the index operation between groups compared (Mann-Whitney U-test, p > 0.40). Cerebrospinal fluid dissemination was radiographically documented in 18 patients (35%) following the index operation. This occurrence was not significantly influenced by either ventricular entry during surgery (Mantel-Cox test, p = 0.13), the proximity of the tumor to the ventricular system (p = 0.63), or these two variables combined (p = 0.28). Survival rate following the index operation was not significantly affected by ventricular entry (p = 0.66), proximity of the tumor to the ventricular system (p = 0.61), or these two variable considered in combination (p = 0.44). However, survival rate was significantly decreased once CSF tumor dissemination had occurred (Cox model, p = 0.03).

scholarly journals Which Factors Increase the Risk of Reoperation After Meniscal Surgery in Children?

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984288 ◽  
Author(s):  
Neeraj M. Patel ◽  
Surya N. Mundluru ◽  
Nicholas A. Beck ◽  
Theodore J. Ganley
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Meniscal Repair ◽  
Activity Level ◽  
Repeat Surgery ◽  
Lower Odds ◽  
White Zone ◽  
Index Operation ◽  
Meniscal Surgery ◽  
The Mean

Background: Meniscal injuries in children can pose treatment challenges, as the meniscus must maintain its biomechanical function over a long lifetime while withstanding a high activity level. While the adult literature contains a plethora of studies regarding risk factors for failure of meniscal surgery, such reports are scarcer in children. Purpose: To determine the rate at which children undergoing meniscal surgery require subsequent reoperation as well as to define risk factors for reoperation in this population. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective institutional database of 907 first-time meniscal surgical procedures performed between 2000 and 2015 was reviewed. All patients were <18 years old. Demographic and intraoperative information was recorded, as were concurrent injuries or operations and subsequent procedures. Univariate analysis consisted of chi-square and independent-samples t tests. Multivariate logistic regression with purposeful selection was then performed to adjust for confounding factors. Results: The mean ± SD patient age was 13.2 ± 2.1 years, and 567 (63%) were male. The mean postoperative follow-up duration was 20.1 ± 10.1 months. Overall, 83 patients (9%) required repeat surgery at a mean of 23.2 months after the index operation. After adjustment for confounders in a multivariate model, meniscal repair resulted in 3.1-times higher odds of reoperation when compared with meniscectomy (95% CI, 1.2-8.3; P = .02), while white-white zone tears had 2.8-times lower odds of reoperation (95% CI, 1.01-7.7; P = .04) versus red-red and red-white zone tears. Conclusion: Approximately 9% of children undergoing meniscal surgery will require reoperation at a mean 23.2 months after the index operation. Repair carried approximately 3-times higher odds of reoperation than meniscectomy, while white-white zone tears had nearly 3-times lower odds of requiring repeat surgery when compared with tears in other zones.

scholarly journals The Role of Interventional Radiology in the Management of Late Postpancreaticoduodenectomy Hemorrhage

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Liang Zhang ◽  
Jun Wang ◽  
Jinhua Jiang ◽  
Jialin Shen
Keyword(s):  
Interventional Radiology ◽  
Success Rate ◽  
Technical Success ◽  
Safe Method ◽  
Technical Success Rate ◽  
Index Operation ◽  
Positive Rate ◽  
Rebleeding Rate ◽  
Overall Mortality

Objective. To explore the role of interventional radiology (IR) in the management of late postpancreaticoduodenectomy hemorrhage (PPH). Materials and Methods. Patients who had late PPH (occurring >24 h after index operation) managed by the IR procedure in our institution between 2013 and 2018 were retrospectively analyzed. Result. Hired patients who were diagnosed with grade B ( n = 10 ) and C ( n = 22 ) late PPH underwent 40 transcatheter arterial angiographies (TAA). The overall positive rate of angiography was 45.0% (18/40). Eighteen transcatheter arterial embolizations (TAEs) were performed, and the technical success rate was 88.89% (16/18). The rebleeding rate after embolization was 18.8% (3/16), and no severe procedure-related complications were recorded. The overall mortality of late PPH was 25.0% (8/32). Conclusion. Nearly half of hemorrhagic sites in late PPH could be identified by TAA. TAE is an effective and safe method for the hemostasia of late PPH in patients with positive angiography results.

Medullary thyroid cancer: What is the optimal management of the lateral neck in a node negative patient at index operation?

Surgery ◽  
2021 ◽  
Author(s):  
Thomas Szabo Yamashita ◽  
Richard T. Rogers ◽  
Trenton R. Foster ◽  
Melanie L. Lyden ◽  
John C. Morris ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Medullary Thyroid Cancer ◽  
Optimal Management ◽  
Lateral Neck ◽  
Node Negative ◽  
Negative Patient ◽  
Medullary Thyroid ◽  
Index Operation

scholarly journals Age, body mass index, and osteoporosis are more predictive than imaging for adjacent-segment reoperation after lumbar fusion

2021 ◽  
Vol 12 ◽  
pp. 453
Author(s):  
Nii-Kwanchie Ankrah ◽  
Ilyas M. Eli ◽  
Subu N. Magge ◽  
Robert G. Whitmore ◽  
Andrew Y. Yew
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Revision Surgery ◽  
Lumbar Fusion ◽  
Univariate Analysis ◽  
Patient Characteristics ◽  
Adjacent Segment ◽  
Index Operation ◽  
T2 Hyperintensity ◽  
Lumbar Spinal

Background: Adjacent-segment disease (ASD) is a well-described long-term complication after lumbar fusion. There is a lack of consensus about the risk factors for development of ASD, but identifying them could improve surgical outcomes. Our goal was to analyze the effect of patient characteristics and radiographic parameters on the development of symptomatic ASD requiring revision surgery after posterior lumbar fusion. Methods: In this retrospective cohort study, we identified patients who underwent lumbar fusion surgery and revision surgery from May 2012 to November 2018 using an institutional lumbar fusion registry. Patients having both pre- and post-operative upright radiographs were included in the study. Revision surgeries for which the index operation was performed at an outside hospital were excluded from analysis. Univariate analysis was conducted on candidate variables, and variables with P< 0.2 were selected for multivariate logistic regression. Results: Of the 106 patients identified, 21 required reoperation (29 months average follow-up). Age >65 years (OR 4.14, 95% CI 1.46–11.76, P= 0.008), body mass index (BMI) >34 (OR 1.13, 95% CI 1.04–1.23, P = 0.004), and osteoporosis (OR 14, 95% CI 1.38–142.42, P = 0.03) were independent predictors of reoperation in the multivariate analysis. Increased facet diastasis at fusion levels (OR 0.60, 95% CI 0.42–0.85, P = 0.004) was associated with reduced reoperation rates. Change in segmental LL at the index operation level, rostral and caudal facet diastasis, vacuum discs, and T2 hyperintensity in the facets were not predictors of reoperation. Conclusion: Age >65, BMI >34, and osteoporosis were independent predictors of adjacent-segment reoperation after lumbar spinal fusion.

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