Gait Analysis Platform for Measuring Surgery Recovery

Gait analysis has evolved significantly during last years due to the great development of the Medical Internet of Things (MIoT) platforms that allow an easy integration of sensors (inertial, magnetic and pressure in our case) to the complex analytics required to compute, not only relevant parameters, but also meaningful indexes. In this paper, we extend a previous development based on a fully wireless pair of insoles by implementing an updated version with more reliable and user-friendly devices, smartphone app and web front-end and back-end. We also extend previous work focused on fall analysis (with the corresponding fall risk index or FRI) with the proposal of a new surgery recovery index (SRI) to account for the individual speed recovery speed that can be measured either at clinical facilities or at home in a telemedicine environment or while doing daily life activities. This new index can be personalized for different types of surgeries that affect gait such as hip, knee, etc. This paper presents the case of hip recovery and is built on top of the clinical standard SPPB test and allows obtaining quantitative parameters directly from the sensors.

Stump and prosthesis. Tregubov (New Surgery, 1926, No. 2)

This old and still sore question was subjected to a thorough examination by Tregubov (Novaya Khirurgiya, 1926, No. 2), who showed on a large statistical material what a large percentage of the stumps are defective.

Nasal and Laryngeal Rhinosporidiosis in Horses Treated with Electrocautery

Background: Rhinosporidiosis is considered an endemic disease in some countries and can affect several species of animals, among them, also equines. In this specie, although the nasal cavity is the most common site of infection, in some cases, it could also be spotted in the larynx region. The present study had as an objective to describe two cases of rhinosporidiosis in horses, one of them nasal and the other in the laryngeal area.Cases: Horse 1. A 12-year-old male Standardbred was sent to the veterinary hospital for the resection of the formation presented in the mucocutaneous junction of the left nostril. During the physical exam, a red mass of a moderately consistency, with an irregular, verrucous, pedunculated and ulcerated surface was observed, measuring approximately 2 centimeters in diameter. The surgical procedure for the resection of the mass was done through the use of the electrocautery technique, with the animal sedated with a romifidine dose of 0.08 mg/kg, a butorphanol dose of 0.04 mg/kg and a local anesthesia of 2% lidocaine. Eight months after the surgical procedure, the animal returned to the hospital and the presence of three new masses was noted in the same nostril, around the region where the extracted mass used to be found and they resembled the previous lesions. The horse’s owner didn’t authorize a new surgery or a new histopathological exam of the lesions. Horse 2. The other case refers to an asymptomatic 15-year-old male mixed breed. During a routine gastroscopic exam, the presence of several reddish coloration nodular and polypoid formations of irregular surface was observed in the larynx. Only one formation in the dorsal portion of the pharynx was observed. During the macroscopic exam, it was observed heterogeneously formation with a grayish-white color and soft consistency aspect. The surgical procedure for the resection of the mass, also through electrocautery, was performed with the animal, previously sedated with a detomidine dose of 0.01 mg/kg and a butorphanol dose of 0.02 mg/kg through intravenous. The contact plate of the electrocautery was fixed to the left side of the animal's neck. After the introduction of the endoscope through the nostril and advancing to the pharynx and larynx, lidocaine 2% without a vasoconstrictor was sprayed in the region. The polyps were individually wrapped by the polypectomy loop, passed through the endoscope operational channel and, at this time, the electrocautery was activated. After the treatment, periodical return appointments were made for the next two months. During the fourth appointment, the animal presented, in the endoscopy, a relapse of a few formations which were, again, removed with electrocautery. The histopathological exam in both cases was characterized by the presence of sporangia that was distributed homogeneously across the submucosal blade interspersed with mild to moderate mixed inflammatory infiltration composed predominantly of lymphoplasmic cells, followed by neutrophils and macrophages, as well as some hemorrhage area and the presence of macrophages with hemosiderin. These histopathological findings were consistent with rhinosporidiosis.Discussion: Rhinosporidiosis in horses, although rare, must be considered not only in cases of nasal formations, their most common form, but also in laryngeal cases, while the use of electrocautery is an efficient technique in the removal of the lesions, allowing for a good tissue healing and no postoperative complications. Nevertheless, follow-ups after treatment is always recommended to identify possible relapses.

New technique of inguinal hernia repair during prostatectomy

Background: Several benefits of inguinal hernia repair concurrent with simple prostatectomy have been proposed recently. For the first time we represent this surgery in the form of retroperitoneal mesh insertion without an additional surgical cut for the inguinal hernia repair. Methods: We selected 19 patients for this trial of a new surgery method. The simple prostatectomy was performed and from the same surgical cut the hernia sac recognized. Two methods of prostatectomy surgery were undertaken: Millin’s and Freyer’s prostatectomy. The retroperitoneal insertion of monofilament polypropylene was undertaken for hernia repair. Results: All patients were prospectively followed for three years for clinical outcomes and hernia recurrence. No complications after surgery, including wound infection, pelvic collections, sepsis and recurrence of the hernia were seen. Conclusions: Our new retroperitoneal mesh insertion technique is safe, effective and simultaneously practical with simple prostatectomy. This new method is strongly recommended to other surgeons, since it has beneficial results with no noteworthy raise in operative duration or further complications.

The Horn Technique for Nasal Tip Support in Rhinoplasty

Introduction The predictability of nasal tip projection and rotation after aesthetic surgery is a challenge. Tongue-in-groove (TIG) is an effective technique to control tip projection and rotation, but there may be a small loss of projection and rotation of the tip lobe due to lack of support between the anterior septal angle and the domus, since this region is sustained by medial crusts suture-linked and interdomus sutures. Objective To describe a new surgery technique in an attempt to correct the lack of support for the nasal tip after lowering the nasal dorsum. Methods The horn technique consists in preserving a square of cartilage during the removal of the nasal dorsum and septum excess in patients with long and projected nose. This piece will give greater support to the TIG technique and greater predictability of the rotation and projection of the nasal tip. Results Between 2016 and 2018, 50 patients with long and projected noses were submitted to the “horn technique” surgery. They were submitted to the TIG technique associated to the horn technique. A retrospective review of the preoperative and postoperative photographs (3 months to 1 year) of these patients treated with the horn technique were analyzed and showed better support of the nasal tip. Conclusion The horn technique provides greater support to the projection and rotation of rhinoplasties in patients with long and projected nose.

Houston: 1956–1960

DeBakey and his team conquer aortic aneurysms in the chest, as well as occluded arteries throughout the body. The Baylor team invents and perfects new instruments and prosthetic arterial substitutes, transforming the practice of vascular surgery. With the new heart-lung machine the Houston group enthusiastically embraces open-heart surgery. The demanding Baylor surgery residency develops. DeBakey becomes a key member of the Second Hoover Commission, which helps establish the National Library of Medicine. DeBakey begins to spread the word of the new surgery by visiting centers worldwide, including in the Soviet Union at the height of the Cold War.

Relevance of Modified Debridement-Irrigation, Antibiotic Therapy and Implant Retention Protocol for the Management of Surgical Site Infections: A Series of 1694 Instrumented Spinal Surgery

Introduction: Management of surgical site infections (SSI) after instrumented spinal surgery remains controversial. The debridement-irrigation, antibiotic therapy and implant retention protocol (DAIR protocol) is safe and effective to treat deep SSI occurring within the 3 months after instrumented spinal surgery.Methods: This retrospective study describes the outcomes of patients treated over a period of 42 months for deep SSI after instrumented spinal surgery according to a modified DAIR protocol.Results: Among 1694 instrumented surgical procedures, deep SSI occurred in 46 patients (2.7%): 41 patients (89%) experienced early SSI (< 1 month), 3 (7%) delayed SSI (from 1 to 3 months), and 2 (4%) late SSI (> 3months). A total of 37 patients had a minimum 1 year of follow-up; among these the modified DAIR protocol was effective in 28 patients (76%) and failed (need for new surgery for persistent signs of SSI beyond 7 days) in 9 patients (24%). Early second-look surgery (≤ 7days) for iterative debridement was performed in 3 patients, who were included in the cured group. Among the 9 patients in whom the modified DAIR protocol failed, none had early second-look surgery; 3 (33%) recovered and were cured at 1 year follow-up, and 6 (66%) relapsed. Overall, among patients with SSI and a minimum 1 year follow-up, the modified DAIR protocol led to healing in 31/37 (84%) patients.Conclusions: The present study supports the effectiveness of a modified DAIR protocol in deep SSI occurring within the 3 months after instrumented spinal surgery. An early second-look surgery for iterative debridement could increase the success rate of this treatment.