Pub Date : 2024-08-08DOI: 10.3390/surgeries5030050
Kinjal D. Vasavada, Dhruv S. Shankar, Amanda Avila, Edward S. Mojica, E. Hurley, Kevin Lehane, Scott Buzin, Jacob F. Oeding, Spencer M. Stein, Guillem Gonzalez-Lomas, Michael J. Alaia, Eric J Strauss, L. Jazrawi, K. Campbell
Background: The use of telerehabilitation after sports medicine procedures such as an arthroscopic rotator cuff repair (ARCR) and anterior cruciate ligament reconstruction (ACLR) has rapidly increased in recent years; however, the functional outcomes and patient satisfaction with telerehabilitation compared to in-person rehabilitation remain unclear. The purpose of this study was to compare the functional outcomes and patient satisfaction with telerehabilitation to in-person rehabilitation in a randomized controlled trial after two common sports procedures, ARCR and ACLR. Methods: Two randomized controlled trials were conducted involving patients scheduled to undergo ARCR or ACLR by one of six fellowship-trained sports medicine surgeons between October 2020 and November 2021. Each trial had an enrollment goal of 60 patients. Subjects were randomized 1:1 to receive telerehabilitation or in-person rehabilitation postoperatively. Functional outcome and satisfaction metrics were collected at baseline and at post-operative visits and compared between groups. Results: In total, 16 ACLR patients were enrolled, of whom 10 (62.5%) were assigned to in-person rehabilitation and 6 (37.5%) to telerehabilitation. Additionally, 32 ARCR patients were enrolled, of whom 20 (62.5%) were assigned in-person rehabilitation and 12 (37.5%) were assigned telerehabilitation. In total, of the 30 patients assigned to in-person rehabilitation, none reported a crossover to telerehabilitation. Of the 18 patients initially assigned to telerehabilitation, 12 (67%) completed the final follow-up survey, of which 11 (92%) reported a crossover; 9 patients completed in-person rehabilitation and 2 patients completed hybrid in-person and telerehabilitation. Conclusions: Patients preferred in-person rehabilitation compared to telerehabilitation after ACLR and ARCR, as evidenced by the nearly ubiquitous crossover from telerehabilitation to in-person rehabilitation in both studies. Our findings suggest that telerehabilitation protocols still need to be perfected, and that there may be a role for a hybrid in-person and tele-rehab model.
{"title":"Severe Attrition and Poor Satisfaction in Patients Undergoing Telerehabilitation vs. Standard In-Person Rehabilitation after Arthroscopic Rotator Cuff Repairs and Anterior Cruciate Ligament Reconstructions","authors":"Kinjal D. Vasavada, Dhruv S. Shankar, Amanda Avila, Edward S. Mojica, E. Hurley, Kevin Lehane, Scott Buzin, Jacob F. Oeding, Spencer M. Stein, Guillem Gonzalez-Lomas, Michael J. Alaia, Eric J Strauss, L. Jazrawi, K. Campbell","doi":"10.3390/surgeries5030050","DOIUrl":"https://doi.org/10.3390/surgeries5030050","url":null,"abstract":"Background: The use of telerehabilitation after sports medicine procedures such as an arthroscopic rotator cuff repair (ARCR) and anterior cruciate ligament reconstruction (ACLR) has rapidly increased in recent years; however, the functional outcomes and patient satisfaction with telerehabilitation compared to in-person rehabilitation remain unclear. The purpose of this study was to compare the functional outcomes and patient satisfaction with telerehabilitation to in-person rehabilitation in a randomized controlled trial after two common sports procedures, ARCR and ACLR. Methods: Two randomized controlled trials were conducted involving patients scheduled to undergo ARCR or ACLR by one of six fellowship-trained sports medicine surgeons between October 2020 and November 2021. Each trial had an enrollment goal of 60 patients. Subjects were randomized 1:1 to receive telerehabilitation or in-person rehabilitation postoperatively. Functional outcome and satisfaction metrics were collected at baseline and at post-operative visits and compared between groups. Results: In total, 16 ACLR patients were enrolled, of whom 10 (62.5%) were assigned to in-person rehabilitation and 6 (37.5%) to telerehabilitation. Additionally, 32 ARCR patients were enrolled, of whom 20 (62.5%) were assigned in-person rehabilitation and 12 (37.5%) were assigned telerehabilitation. In total, of the 30 patients assigned to in-person rehabilitation, none reported a crossover to telerehabilitation. Of the 18 patients initially assigned to telerehabilitation, 12 (67%) completed the final follow-up survey, of which 11 (92%) reported a crossover; 9 patients completed in-person rehabilitation and 2 patients completed hybrid in-person and telerehabilitation. Conclusions: Patients preferred in-person rehabilitation compared to telerehabilitation after ACLR and ARCR, as evidenced by the nearly ubiquitous crossover from telerehabilitation to in-person rehabilitation in both studies. Our findings suggest that telerehabilitation protocols still need to be perfected, and that there may be a role for a hybrid in-person and tele-rehab model.","PeriodicalId":506240,"journal":{"name":"Surgeries","volume":"34 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141928414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-12DOI: 10.3390/surgeries5020036
F. H. Z. Chua, Tien Meng Cheong, R. Kirollos, L. Ng, W. Seow, Sharon Y. Y. Low
(1) Background: Pediatric intracranial aneurysms (PIA) are rare and clinicopathologically distinct neurovascular entities. The aims of this study are to evaluate our institution’s experience and corroborate our results with updated literature. (2) Methods: This is a single-institution, retrospective study. Patients with a confirmed diagnosis of PIA are included. Variables of interest include patient demographics, clinical presentation, treatment outcomes and features specific to each patient’s PIA. A literature review on PIA-centric clinical studies was conducted. (3) Results: A total of 14 PIAs in 11 patients were treated from 2000 to 2022. The mean age was 5.8 years old, and most were males (90.1%). Anterior circulation PIAs constituted 78.6% of the cohort. Half of the PIAs were of the dissecting type, and 14.3% were giant aneurysms. Of interest, 14.3% of patients had subsequent de novo aneurysms after treatment of their index aneurysm. For treatment, 57.1% underwent surgery, 35.7% had endovascular intervention and the remaining 7.1% were managed conservatively. Based on the literature review, this study had congruent findings to other existing publications. (4) Conclusions: PIAs are unique neurovascular lesions that have good outcomes if managed in a timely fashion by an experienced multidisciplinary team. We recommend longer surveillance periods due to the risk of developing de novo aneurysms.
(1) 背景：小儿颅内动脉瘤（PIA）是一种罕见的、临床病理上独特的神经血管实体。本研究旨在评估我院的经验，并根据最新文献证实我们的结果。(2）方法：这是一项单一机构的回顾性研究。研究对象包括确诊为 PIA 的患者。研究变量包括患者的人口统计学特征、临床表现、治疗结果以及每位患者 PIA 的具体特征。还对以 PIA 为中心的临床研究进行了文献综述。(3) 结果：从 2000 年到 2022 年，共有 11 名患者的 14 例 PIA 接受了治疗。患者平均年龄为 5.8 岁，大多数为男性（90.1%）。前循环 PIA 占总数的 78.6%。半数 PIA 为剥离型，14.3% 为巨大动脉瘤。值得注意的是，14.3%的患者在治疗了动脉瘤后又出现了新生动脉瘤。在治疗方面，57.1%的患者接受了手术，35.7%的患者接受了血管内介入治疗，其余7.1%的患者接受了保守治疗。根据文献综述，本研究的结果与其他现有文献一致。(4) 结论：PIA 是一种独特的神经血管病变，如果由经验丰富的多学科团队及时处理，会取得良好的疗效。由于存在新生动脉瘤的风险，我们建议延长监测时间。
{"title":"Pediatric Intracranial Aneurysms: Experience from a Singapore Children’s Hospital","authors":"F. H. Z. Chua, Tien Meng Cheong, R. Kirollos, L. Ng, W. Seow, Sharon Y. Y. Low","doi":"10.3390/surgeries5020036","DOIUrl":"https://doi.org/10.3390/surgeries5020036","url":null,"abstract":"(1) Background: Pediatric intracranial aneurysms (PIA) are rare and clinicopathologically distinct neurovascular entities. The aims of this study are to evaluate our institution’s experience and corroborate our results with updated literature. (2) Methods: This is a single-institution, retrospective study. Patients with a confirmed diagnosis of PIA are included. Variables of interest include patient demographics, clinical presentation, treatment outcomes and features specific to each patient’s PIA. A literature review on PIA-centric clinical studies was conducted. (3) Results: A total of 14 PIAs in 11 patients were treated from 2000 to 2022. The mean age was 5.8 years old, and most were males (90.1%). Anterior circulation PIAs constituted 78.6% of the cohort. Half of the PIAs were of the dissecting type, and 14.3% were giant aneurysms. Of interest, 14.3% of patients had subsequent de novo aneurysms after treatment of their index aneurysm. For treatment, 57.1% underwent surgery, 35.7% had endovascular intervention and the remaining 7.1% were managed conservatively. Based on the literature review, this study had congruent findings to other existing publications. (4) Conclusions: PIAs are unique neurovascular lesions that have good outcomes if managed in a timely fashion by an experienced multidisciplinary team. We recommend longer surveillance periods due to the risk of developing de novo aneurysms.","PeriodicalId":506240,"journal":{"name":"Surgeries","volume":"18 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141350016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-17DOI: 10.3390/surgeries5020035
Sydney N. Phu, David J. Leishman, Sierra D. Palmer, S. Oppler, Melanie N. Niewinski, Lucas A. Mutch, Jill S. Faustich, Andrew B. Adams, Robert T. Tranquillo, Melanie L. Graham
Anticoagulant and antiplatelet therapies are used to prevent life-threatening complications associated with thrombosis. While there are numerous clinical guidelines for antithrombotic medications, there is an incomplete understanding of whether these interventions yield similar effects in preclinical models, potentially impacting their predictive value for translational studies on the development of medical devices, therapies, and surgical techniques. Due to their close physiologic similarities to humans, we employed nonhuman primates (NHPs) using a reverse translational approach to analyze the response to clinical regimens of unfractionated heparin, low-molecular-weight heparin (LMWH) and aspirin to assess concordance with typical human responses and evaluate the predictive validity of this model. We evaluate activated clotting time (ACT) in nine rhesus and six cynomolgus macaques following the intraoperative administration of intravenous unfractionated heparin (100–300 U/kg) reflecting the clinical dose range. We observed a significant dose-dependent effect of heparin on ACT (low-dose average = 114.1 s; high-dose average = 148.3 s; p = 0.0011). LMWH and aspirin, common clinical antithrombotic prophylactics, were evaluated in three rhesus macaques. NHPs achieved therapeutic Anti-Xa levels (mean = 0.64 U/mL) and ARU (mean = 459) via VerifyNow, adhering to clinical guidance using 1.0 mg/kg enoxaparin and 81 mg aspirin. Clinical dosing strategies for unfractionated heparin, LMWH, and aspirin were safe and effective in NHPs, with no development of thrombosis or bleeding complications intraoperatively, postoperatively, or for prophylaxis. Our findings suggest that coagulation studies, performed as an integrative part of studies on biologics, bioengineered devices, or transplantation in NHPs, can be extrapolated to the clinical situation with high predictive validity.
{"title":"Evaluating Anticoagulant and Antiplatelet Therapies in Rhesus and Cynomolgus Macaques for Predictive Modeling in Humans","authors":"Sydney N. Phu, David J. Leishman, Sierra D. Palmer, S. Oppler, Melanie N. Niewinski, Lucas A. Mutch, Jill S. Faustich, Andrew B. Adams, Robert T. Tranquillo, Melanie L. Graham","doi":"10.3390/surgeries5020035","DOIUrl":"https://doi.org/10.3390/surgeries5020035","url":null,"abstract":"Anticoagulant and antiplatelet therapies are used to prevent life-threatening complications associated with thrombosis. While there are numerous clinical guidelines for antithrombotic medications, there is an incomplete understanding of whether these interventions yield similar effects in preclinical models, potentially impacting their predictive value for translational studies on the development of medical devices, therapies, and surgical techniques. Due to their close physiologic similarities to humans, we employed nonhuman primates (NHPs) using a reverse translational approach to analyze the response to clinical regimens of unfractionated heparin, low-molecular-weight heparin (LMWH) and aspirin to assess concordance with typical human responses and evaluate the predictive validity of this model. We evaluate activated clotting time (ACT) in nine rhesus and six cynomolgus macaques following the intraoperative administration of intravenous unfractionated heparin (100–300 U/kg) reflecting the clinical dose range. We observed a significant dose-dependent effect of heparin on ACT (low-dose average = 114.1 s; high-dose average = 148.3 s; p = 0.0011). LMWH and aspirin, common clinical antithrombotic prophylactics, were evaluated in three rhesus macaques. NHPs achieved therapeutic Anti-Xa levels (mean = 0.64 U/mL) and ARU (mean = 459) via VerifyNow, adhering to clinical guidance using 1.0 mg/kg enoxaparin and 81 mg aspirin. Clinical dosing strategies for unfractionated heparin, LMWH, and aspirin were safe and effective in NHPs, with no development of thrombosis or bleeding complications intraoperatively, postoperatively, or for prophylaxis. Our findings suggest that coagulation studies, performed as an integrative part of studies on biologics, bioengineered devices, or transplantation in NHPs, can be extrapolated to the clinical situation with high predictive validity.","PeriodicalId":506240,"journal":{"name":"Surgeries","volume":"1 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140964022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-16DOI: 10.3390/surgeries5020034
Marcello Della Corte, Elisa Cerchia, Marco Allasia, Alessandro Marquis, Alessandra Linari, Martina Mandaletti, Elena Ruggiero, Andrea Sterrantino, Paola Quarello, Massimo Catti, Franca Fagioli, Paolo Gontero, Simona Gerocarni Nappo
The Bosniak classification of renal cysts aims to provide a probabilistic risk assessment indicating the likelihood of malignancy from imaging findings. Originally designed to classify adult renal cysts based on computed tomography findings, the Bosniak classification has been extended to pediatric patients, with some adjustments made with the aim of accommodating magnetic resonance imaging (MRI) and ultrasonography (US). Bosniak IV lesions are rare in adolescents, indicating localized renal cell carcinoma and requiring surgical intervention. In contrast, Bosniak III lesions can be treated conservatively, although there is a lack of specific guidelines on their management. We present a case of a 14-year-old boy with a Bosniak III lesion, which was incidentally detected during the US evaluation of a left varicocele. After a 12-month follow-up, MRI revealed progression to a Bosniak IV cyst. Robot-assisted tumor enucleation was performed with selective artery clamping when the patient was 15. Histopathology showed tubulocystic renal cell carcinoma without adverse features. Immunocytochemistry supported a favorable prognosis of this rare tumor (<1% of renal tumor), thus obviating the need for adjuvant treatment. At the 18-month follow-up, no recurrence or distant metastasis were observed. This case highlights the importance of an aggressive treatment in persistent Bosniak III and Bosniak IV renal cysts in children and adolescents and the necessity to offer a nephron-sparing surgery.
Bosniak肾囊肿分类法旨在提供一种概率风险评估，根据成像结果显示恶性肿瘤的可能性。Bosniak分类法最初是根据计算机断层扫描结果对成人肾囊肿进行分类，现已扩展到儿科患者，并根据磁共振成像（MRI）和超声波成像（US）进行了一些调整。波 Bosniak IV 型病变在青少年中很少见，表明是局部肾细胞癌，需要手术治疗。与此相反，Bosniak III 型病变可采取保守治疗，但目前还缺乏具体的治疗指南。我们介绍了一例患有 Bosniak III 病变的 14 岁男孩，该病变是在对左侧精索静脉曲张进行 US 评估时偶然发现的。经过 12 个月的随访，核磁共振成像显示该病变发展为波什尼亚克 IV 型囊肿。患者 15 岁时，在机器人辅助下进行了肿瘤切除术，并选择性夹闭动脉。组织病理学显示为肾小管囊性细胞癌，无不良特征。免疫细胞化学证实这种罕见肿瘤（在肾肿瘤中占比小于1%）预后良好，因此无需进行辅助治疗。在 18 个月的随访中，未发现复发或远处转移。该病例强调了积极治疗儿童和青少年顽固性波什尼亚克 III 型和波什尼亚克 IV 型肾囊肿的重要性，以及进行保肾手术的必要性。
{"title":"A Bosniak III Cyst Unmasking Tubulocystic Renal Cell Carcinoma in an Adolescent: Management with Selective Arterial Clamping and Robotic Enucleation","authors":"Marcello Della Corte, Elisa Cerchia, Marco Allasia, Alessandro Marquis, Alessandra Linari, Martina Mandaletti, Elena Ruggiero, Andrea Sterrantino, Paola Quarello, Massimo Catti, Franca Fagioli, Paolo Gontero, Simona Gerocarni Nappo","doi":"10.3390/surgeries5020034","DOIUrl":"https://doi.org/10.3390/surgeries5020034","url":null,"abstract":"The Bosniak classification of renal cysts aims to provide a probabilistic risk assessment indicating the likelihood of malignancy from imaging findings. Originally designed to classify adult renal cysts based on computed tomography findings, the Bosniak classification has been extended to pediatric patients, with some adjustments made with the aim of accommodating magnetic resonance imaging (MRI) and ultrasonography (US). Bosniak IV lesions are rare in adolescents, indicating localized renal cell carcinoma and requiring surgical intervention. In contrast, Bosniak III lesions can be treated conservatively, although there is a lack of specific guidelines on their management. We present a case of a 14-year-old boy with a Bosniak III lesion, which was incidentally detected during the US evaluation of a left varicocele. After a 12-month follow-up, MRI revealed progression to a Bosniak IV cyst. Robot-assisted tumor enucleation was performed with selective artery clamping when the patient was 15. Histopathology showed tubulocystic renal cell carcinoma without adverse features. Immunocytochemistry supported a favorable prognosis of this rare tumor (<1% of renal tumor), thus obviating the need for adjuvant treatment. At the 18-month follow-up, no recurrence or distant metastasis were observed. This case highlights the importance of an aggressive treatment in persistent Bosniak III and Bosniak IV renal cysts in children and adolescents and the necessity to offer a nephron-sparing surgery.","PeriodicalId":506240,"journal":{"name":"Surgeries","volume":"34 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140967503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-15DOI: 10.3390/surgeries5020033
Rayan Ben Letaifa, Tarek Klaylat, Magdalena Tarchala, Chan Gao, Prism Schneider, Derek H. Rosenzweig, Paul A. Martineau, Rahul Gawri
Bone healing occurs through three consecutive and interdependent phases. While the acute inflammatory response is vital to fracture healing, chronic and systemic inflammation negatively affect the healing process. The bone tissue relies heavily on the immune system for its normal physiology and turnover. The interactions are more pronounced in injury states, such as fractures and autoimmune disorders. Recently, the field of osteoimmunology, the study of the molecular interplay of the immune and skeletal systems, has gained much-needed attention to develop new therapeutic strategies to accelerate fracture healing and prevent the complications of fracture healing. This review provides an overview of the process of fracture healing and discusses the role of immune cells, their interplay with the released cytokines, and the current state of the art in the field of osteoimmunology.
{"title":"Osteoimmunology: An Overview of the Interplay of the Immune System and the Bone Tissue in Fracture Healing","authors":"Rayan Ben Letaifa, Tarek Klaylat, Magdalena Tarchala, Chan Gao, Prism Schneider, Derek H. Rosenzweig, Paul A. Martineau, Rahul Gawri","doi":"10.3390/surgeries5020033","DOIUrl":"https://doi.org/10.3390/surgeries5020033","url":null,"abstract":"Bone healing occurs through three consecutive and interdependent phases. While the acute inflammatory response is vital to fracture healing, chronic and systemic inflammation negatively affect the healing process. The bone tissue relies heavily on the immune system for its normal physiology and turnover. The interactions are more pronounced in injury states, such as fractures and autoimmune disorders. Recently, the field of osteoimmunology, the study of the molecular interplay of the immune and skeletal systems, has gained much-needed attention to develop new therapeutic strategies to accelerate fracture healing and prevent the complications of fracture healing. This review provides an overview of the process of fracture healing and discusses the role of immune cells, their interplay with the released cytokines, and the current state of the art in the field of osteoimmunology.","PeriodicalId":506240,"journal":{"name":"Surgeries","volume":"8 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140974428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-11DOI: 10.3390/surgeries5020032
Marta Forte, Giuseppe Barile, Antonio D’Amati, Giuseppe Ingravallo, Massimo Corsalini, Alfonso Manfuso, Gianfranco Favia, Saverio Capodiferro
Peripheral developing odontoma is a rare odontogenic lesion that mostly occurs in children. Their clinical and radiological features generally provide clinical suspicion of a benign lesion but only a histological examination may lead to the final diagnosis. Surgical management is generally easy and resolutive, but it can become more complicated in uncooperative patients and may thus require additional procedures to perform a fit surgery. We report a case of peripheral developing odontoma of the palatal aspect of the anterior maxilla that occurred in an uncooperative child subsequently treated by diode laser surgery, highlighting the benefit of this kind of surgery in pediatric patients. Data from the literature on peripheral developing odontoma have been collected and discussed with a narrative review.
{"title":"Diode Laser Surgery of Peripheral Developing Odontoma in a Pediatric Patient: A Case Report with Narrative Review of the Literature","authors":"Marta Forte, Giuseppe Barile, Antonio D’Amati, Giuseppe Ingravallo, Massimo Corsalini, Alfonso Manfuso, Gianfranco Favia, Saverio Capodiferro","doi":"10.3390/surgeries5020032","DOIUrl":"https://doi.org/10.3390/surgeries5020032","url":null,"abstract":"Peripheral developing odontoma is a rare odontogenic lesion that mostly occurs in children. Their clinical and radiological features generally provide clinical suspicion of a benign lesion but only a histological examination may lead to the final diagnosis. Surgical management is generally easy and resolutive, but it can become more complicated in uncooperative patients and may thus require additional procedures to perform a fit surgery. We report a case of peripheral developing odontoma of the palatal aspect of the anterior maxilla that occurred in an uncooperative child subsequently treated by diode laser surgery, highlighting the benefit of this kind of surgery in pediatric patients. Data from the literature on peripheral developing odontoma have been collected and discussed with a narrative review.","PeriodicalId":506240,"journal":{"name":"Surgeries","volume":"120 43","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140987279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-10DOI: 10.3390/surgeries5020031
Wooyoung Jang, Jad F. Zeitouni, Daniel K. Nguyen, Ismail S. Mohiuddin, Haven Ward, Anu Satheeshkumar, Yusuf Dundar
Background: Inflammation has long been a key tenet in the diagnosis and management of malignancies, likely contributing to cancer incidence, staging, and progression. Systemic inflammation, in particular, is often elevated prior to and during cancer development. Systemic inflammation in the context of cancer diagnosis and monitoring is measured by various inflammatory indexes such as the systemic inflammatory response index (SIRI), plasma-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and neutrophil-to-lymphocyte ratio (NLR). We set out to determine the relationship between pre- and post-treatment levels of these inflammatory indexes and the prognosis and outcomes of oropharyngeal cancer (OPC). Methods: A retrospective chart review was performed of 172 patients with OPC who underwent treatment for oropharyngeal cancer at University Medical Center in Lubbock, TX between May 2013 to May 2023. Sites of primary cancer were obtained through chart review. HPV infection status and differentiation of the tumor were noted for each patient. Treatment modalities were classified as surgery, radiation, chemotherapy, or concurrent chemotherapy and radiation. Treatment outcomes were classified based on recurrence and death secondary to disease. The relationships between treatment outcome and the described inflammatory indexes were evaluated. Appropriate parametric tests were selected based on the large number of variables. Results: Pre-treatment SIRI and Albumin levels were positively predictive in determining locoregional recurrence (p = 0.031 and p = 0.039). NLR, SII, and SIRI levels taken at three months post-treatment were also found to be positively predictive of locoregional recurrence (p = 0.005, p < 0.0005, and p = 0.007). SIRI taken at six months post-treatment was also found to be positively predictive of locoregional recurrence (p = 0.008). SII at six months post-treatment was found to be positively predictive of survival (p = 0.027). Conclusion: This study suggested that post-treatment levels of several inflammatory indexes, particularly SIRI, NLR, and SII, may be useful in determining the long-term outlook and recurrence of head and neck cancer following treatment.
背景：长期以来，炎症一直是诊断和治疗恶性肿瘤的一个重要原则，很可能与癌症的发病率、分期和进展有关。尤其是在癌症发生之前和期间，全身炎症往往会升高。癌症诊断和监测中的全身炎症可通过各种炎症指数来测量，如全身炎症反应指数（SIRI）、血浆与淋巴细胞比值（PLR）、全身免疫炎症指数（SII）和中性粒细胞与淋巴细胞比值（NLR）。我们旨在确定这些炎症指数的治疗前和治疗后水平与口咽癌（OPC）的预后和疗效之间的关系。研究方法我们对2013年5月至2023年5月期间在德克萨斯州卢博克大学医学中心接受口咽癌治疗的172名口咽癌患者进行了回顾性病历审查。通过病历审查获得了原发癌的部位。记录了每位患者的 HPV 感染情况和肿瘤分化情况。治疗方式分为手术、放疗、化疗或同时化疗和放疗。治疗结果根据复发和继发死亡进行分类。对治疗结果与所述炎症指标之间的关系进行了评估。由于变量较多，因此选择了适当的参数检验。结果治疗前的 SIRI 和白蛋白水平对确定局部复发有积极的预测作用（p = 0.031 和 p = 0.039）。治疗后三个月的 NLR、SII 和 SIRI 水平也对局部复发有积极的预测作用（p = 0.005、p < 0.0005 和 p = 0.007）。治疗后 6 个月的 SIRI 也可预测局部复发（p = 0.008）。治疗后 6 个月的 SII 对生存率有积极的预测作用（p = 0.027）。结论这项研究表明，治疗后的几项炎症指标，尤其是 SIRI、NLR 和 SII 水平，可能有助于判断头颈部癌症治疗后的长期前景和复发情况。
{"title":"The Effectiveness of Inflammatory Indexes in Assessing Oropharyngeal Cancer Prognosis","authors":"Wooyoung Jang, Jad F. Zeitouni, Daniel K. Nguyen, Ismail S. Mohiuddin, Haven Ward, Anu Satheeshkumar, Yusuf Dundar","doi":"10.3390/surgeries5020031","DOIUrl":"https://doi.org/10.3390/surgeries5020031","url":null,"abstract":"Background: Inflammation has long been a key tenet in the diagnosis and management of malignancies, likely contributing to cancer incidence, staging, and progression. Systemic inflammation, in particular, is often elevated prior to and during cancer development. Systemic inflammation in the context of cancer diagnosis and monitoring is measured by various inflammatory indexes such as the systemic inflammatory response index (SIRI), plasma-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and neutrophil-to-lymphocyte ratio (NLR). We set out to determine the relationship between pre- and post-treatment levels of these inflammatory indexes and the prognosis and outcomes of oropharyngeal cancer (OPC). Methods: A retrospective chart review was performed of 172 patients with OPC who underwent treatment for oropharyngeal cancer at University Medical Center in Lubbock, TX between May 2013 to May 2023. Sites of primary cancer were obtained through chart review. HPV infection status and differentiation of the tumor were noted for each patient. Treatment modalities were classified as surgery, radiation, chemotherapy, or concurrent chemotherapy and radiation. Treatment outcomes were classified based on recurrence and death secondary to disease. The relationships between treatment outcome and the described inflammatory indexes were evaluated. Appropriate parametric tests were selected based on the large number of variables. Results: Pre-treatment SIRI and Albumin levels were positively predictive in determining locoregional recurrence (p = 0.031 and p = 0.039). NLR, SII, and SIRI levels taken at three months post-treatment were also found to be positively predictive of locoregional recurrence (p = 0.005, p < 0.0005, and p = 0.007). SIRI taken at six months post-treatment was also found to be positively predictive of locoregional recurrence (p = 0.008). SII at six months post-treatment was found to be positively predictive of survival (p = 0.027). Conclusion: This study suggested that post-treatment levels of several inflammatory indexes, particularly SIRI, NLR, and SII, may be useful in determining the long-term outlook and recurrence of head and neck cancer following treatment.","PeriodicalId":506240,"journal":{"name":"Surgeries","volume":" 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140992297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.3390/surgeries5020030
Simone Amato, S. Nisticò, L. Bennardo, Giovanni Pellacani, G. Cannarozzo
This study explores the innovative use of CO2 laser technology in frenuloplasty, a significant shift from classic methods like scalpel surgery or electrocautery towards a minimally invasive approach. The research involved 15 patients aged 25 to 50, undergoing frenuloplasty with a CO2 laser system equipped with a 7-inch defocused handpiece, set at 20 Hz and 0.3 W. This method diverges from conventional laser techniques, focusing on controlled laser passes combined with manual traction to elongate the fibrous tissue of the frenulum. The results demonstrated that the CO2 laser technique allowed for a precise and progressive modification of the frenulum, significantly reducing the risks of hemorrhage and secondary intention fibrosis. The healing process was notably expedited, with patients reporting satisfactory outcomes within a two-week period. Statistically significant improvements were observed in patient-reported outcomes, as evidenced by the increases in the Short Form Health Survey (SF-12) scores, with the mean Physical Component Summary (PCS) score rising from 32.5 to 47.5 and the mean Mental Component Summary (MCS) score from 39.3 to 52.3 (p < 0.001 for both). The study concludes that CO2 laser frenuloplasty is an effective and safe technique, offering substantial benefits in terms of reduced healing time and enhanced patient satisfaction. The significant improvements in SF-12 scores underscore the positive impact on patient quality of life, advocating for the broader application of this technique in clinical practice. Further research is warranted to explore its potential in a wider clinical context.
{"title":"CO2 Laser Frenuloplasty: Advancing Minimally Invasive Techniques for Rapid Healing and Improved Patient Outcomes","authors":"Simone Amato, S. Nisticò, L. Bennardo, Giovanni Pellacani, G. Cannarozzo","doi":"10.3390/surgeries5020030","DOIUrl":"https://doi.org/10.3390/surgeries5020030","url":null,"abstract":"This study explores the innovative use of CO2 laser technology in frenuloplasty, a significant shift from classic methods like scalpel surgery or electrocautery towards a minimally invasive approach. The research involved 15 patients aged 25 to 50, undergoing frenuloplasty with a CO2 laser system equipped with a 7-inch defocused handpiece, set at 20 Hz and 0.3 W. This method diverges from conventional laser techniques, focusing on controlled laser passes combined with manual traction to elongate the fibrous tissue of the frenulum. The results demonstrated that the CO2 laser technique allowed for a precise and progressive modification of the frenulum, significantly reducing the risks of hemorrhage and secondary intention fibrosis. The healing process was notably expedited, with patients reporting satisfactory outcomes within a two-week period. Statistically significant improvements were observed in patient-reported outcomes, as evidenced by the increases in the Short Form Health Survey (SF-12) scores, with the mean Physical Component Summary (PCS) score rising from 32.5 to 47.5 and the mean Mental Component Summary (MCS) score from 39.3 to 52.3 (p < 0.001 for both). The study concludes that CO2 laser frenuloplasty is an effective and safe technique, offering substantial benefits in terms of reduced healing time and enhanced patient satisfaction. The significant improvements in SF-12 scores underscore the positive impact on patient quality of life, advocating for the broader application of this technique in clinical practice. Further research is warranted to explore its potential in a wider clinical context.","PeriodicalId":506240,"journal":{"name":"Surgeries","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140995326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-08DOI: 10.3390/surgeries5020029
Miriam Alves de Oliveira, Alexandra Arcanjo, Filipe Castro, Juliana Campos Hasse Fernandes, G. Fernandes
Objective: This systematic review was carried out with the primary objective of verifying which suture (polyamide or silk) of two non-resorbable suture materials with different structures had better/greater tensile strength/resistance to tension, thereby presenting better mechanical behavior. The secondary objective was to verify which one had better performance. The null hypothesis was that both types of sutures had the same behavior. Methods: This systematic study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The focused clinical question was: “In patients that underwent oral surgery treatment (P), is there significantly higher tensile strength/resistance for silk sutures (I) or for polyamide sutures (C) when comparing the outcomes (O)?” The bibliographic search was conducted on ScienceDirect, B-On, and PubMed/MedLine between March and May 2023. The following MeSH terms were defined: sutures, breaking strength, tensile strength, oral surgery, and dentistry, which were articulated and combined using Boolean operators. There were restrictions, such as articles published in Portuguese, Spanish, or English between 1 January 2018 and 3 April 2023. The quality assessment involved the use of the Joanna Briggs Institute (JBI) checklist for RCTs and the QUIN tool (Quality Assessment Tool For In Vitro Studies) for in vitro assays. Results: Ten articles were included in this review (eight in vitro studies and two RCTs). For the RCTs, there were moderate and high levels of bias, whereas in the in vitro studies, three were classified as having a high risk of bias and five as moderate risk. The results proved that suture thread with a monofilament polyamide physical structure causes a less inflammatory reaction owing to less bacterial retention and capillarity, while multifilament sutures, such as silk, have superior mechanical characteristics. Regarding hydration, the evidence demonstrated that the preservation and stability of mechanical properties lacked uniformity. Otherwise, hyaluronic acid (HA) presents a promising solution with the same characteristics and antibacterial capabilities. Conclusion: It was possible to reject the null hypothesis that both types of sutures had the same behavior and result. It was proven by the results above that sutures with a monofilament polyamide physical structure cause a less inflammatory reaction owing to less bacterial retention and capillarity. In contrast, multifilament sutures (silk) have superior mechanical characteristics. Regarding hydration using chlorohexidine in surgical sites, the evidence demonstrated in the preservation and stability of mechanical properties lacks uniformity and congruence. However, HA seems to present a promising option with the same characteristics and antibacterial capabilities.
{"title":"Evaluating and Comparing the Tensile Strength and Clinical Behavior of Monofilament Polyamide and Multifilament Silk Sutures: A Systematic Review","authors":"Miriam Alves de Oliveira, Alexandra Arcanjo, Filipe Castro, Juliana Campos Hasse Fernandes, G. Fernandes","doi":"10.3390/surgeries5020029","DOIUrl":"https://doi.org/10.3390/surgeries5020029","url":null,"abstract":"Objective: This systematic review was carried out with the primary objective of verifying which suture (polyamide or silk) of two non-resorbable suture materials with different structures had better/greater tensile strength/resistance to tension, thereby presenting better mechanical behavior. The secondary objective was to verify which one had better performance. The null hypothesis was that both types of sutures had the same behavior. Methods: This systematic study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The focused clinical question was: “In patients that underwent oral surgery treatment (P), is there significantly higher tensile strength/resistance for silk sutures (I) or for polyamide sutures (C) when comparing the outcomes (O)?” The bibliographic search was conducted on ScienceDirect, B-On, and PubMed/MedLine between March and May 2023. The following MeSH terms were defined: sutures, breaking strength, tensile strength, oral surgery, and dentistry, which were articulated and combined using Boolean operators. There were restrictions, such as articles published in Portuguese, Spanish, or English between 1 January 2018 and 3 April 2023. The quality assessment involved the use of the Joanna Briggs Institute (JBI) checklist for RCTs and the QUIN tool (Quality Assessment Tool For In Vitro Studies) for in vitro assays. Results: Ten articles were included in this review (eight in vitro studies and two RCTs). For the RCTs, there were moderate and high levels of bias, whereas in the in vitro studies, three were classified as having a high risk of bias and five as moderate risk. The results proved that suture thread with a monofilament polyamide physical structure causes a less inflammatory reaction owing to less bacterial retention and capillarity, while multifilament sutures, such as silk, have superior mechanical characteristics. Regarding hydration, the evidence demonstrated that the preservation and stability of mechanical properties lacked uniformity. Otherwise, hyaluronic acid (HA) presents a promising solution with the same characteristics and antibacterial capabilities. Conclusion: It was possible to reject the null hypothesis that both types of sutures had the same behavior and result. It was proven by the results above that sutures with a monofilament polyamide physical structure cause a less inflammatory reaction owing to less bacterial retention and capillarity. In contrast, multifilament sutures (silk) have superior mechanical characteristics. Regarding hydration using chlorohexidine in surgical sites, the evidence demonstrated in the preservation and stability of mechanical properties lacks uniformity and congruence. However, HA seems to present a promising option with the same characteristics and antibacterial capabilities.","PeriodicalId":506240,"journal":{"name":"Surgeries","volume":" 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141000852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-07DOI: 10.3390/surgeries5020028
Michael Chaney, Alexander Ko, Samuel Coster, Saad Shebrain, Jason Ryan
Background: Carotid body tumors (CBTs) are rare benign tumors that arise from the chemoreceptor tissue located at the carotid bifurcation that require excision if symptomatic. Depending on the size and location of the tumor, the carotid artery may need to be repaired after resection. This study aims to assess whether CBT excision with artery resection had higher rates of 30-day postoperative outcomes compared with CBT excision without artery resection. Methods: This is a retrospective cohort study. Patients were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry from 2005 to 2017. They were divided into two groups, based on Current Procedural Terminology (CPT®) codes: group A had CBT excision without carotid artery excision (CPT code 60600) and group B with carotid artery excision (CPT code 60605). Patient demographic characteristics, co-morbidities, and 30-days postoperative outcomes were compared between the two groups. Categorical data were analyzed using Pearson’s X2 or Fisher exact tests and presented as proportions (percentages). Continuous data were analyzed using parametric or non-parametric tests as appropriate. Statistical significance was defined as p < 0.05. Statistical analysis was performed using the SPSS statistical software package. Results: A total of 463 patients were identified, 410 (88.4%) in group A and 53 (11.4%) in group B. Overall, there were 291 (62.9%) women. A higher proportion of women underwent CBT excision only, compared to men (91.1% [265/291] vs. 84.3% [145/172], p < 0.0001). Demographics and comorbidities were similar between groups. There was no significant difference in the 30-day postoperative outcomes. The reoperation rate was higher in group B (3.8% vs. 1.5%, p = 0.334), while the readmission rate was higher in group A (3.2% vs. 0% p = 0.269), and both were not significantly different. Overall morbidity and serious morbidity were higher in group B (7.5% vs. 5.9%, p = 0.626) and lower in group A (5.7% vs. 3.9%, p = 0.544), respectively, but were not significantly different. Operative time (mean, SD) was higher in group B (187 ± 107 vs. 138 ± 66 min, p < 0.001). However, the median (IQR) of hospital length of stay (LOS) was similar (2 [1, 4] vs. 2 [1, 3] days, p = 0.134). Conclusions: Overall, no difference was noted in the 30-day postoperative outcome between the two surgical approaches of CBT. However, operative time was longer when artery resection was performed. Further research to determine the factors predicting the need for carotid artery resection among patient gender is needed.
{"title":"Carotid Body Tumor Excision with and without Carotid Artery Reconstruction: Equivalency of 30-Day Outcomes over 12 Years in the American College of Surgery National Surgical Quality Improvement Program (ACS-NSQIP) Database","authors":"Michael Chaney, Alexander Ko, Samuel Coster, Saad Shebrain, Jason Ryan","doi":"10.3390/surgeries5020028","DOIUrl":"https://doi.org/10.3390/surgeries5020028","url":null,"abstract":"Background: Carotid body tumors (CBTs) are rare benign tumors that arise from the chemoreceptor tissue located at the carotid bifurcation that require excision if symptomatic. Depending on the size and location of the tumor, the carotid artery may need to be repaired after resection. This study aims to assess whether CBT excision with artery resection had higher rates of 30-day postoperative outcomes compared with CBT excision without artery resection. Methods: This is a retrospective cohort study. Patients were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry from 2005 to 2017. They were divided into two groups, based on Current Procedural Terminology (CPT®) codes: group A had CBT excision without carotid artery excision (CPT code 60600) and group B with carotid artery excision (CPT code 60605). Patient demographic characteristics, co-morbidities, and 30-days postoperative outcomes were compared between the two groups. Categorical data were analyzed using Pearson’s X2 or Fisher exact tests and presented as proportions (percentages). Continuous data were analyzed using parametric or non-parametric tests as appropriate. Statistical significance was defined as p < 0.05. Statistical analysis was performed using the SPSS statistical software package. Results: A total of 463 patients were identified, 410 (88.4%) in group A and 53 (11.4%) in group B. Overall, there were 291 (62.9%) women. A higher proportion of women underwent CBT excision only, compared to men (91.1% [265/291] vs. 84.3% [145/172], p < 0.0001). Demographics and comorbidities were similar between groups. There was no significant difference in the 30-day postoperative outcomes. The reoperation rate was higher in group B (3.8% vs. 1.5%, p = 0.334), while the readmission rate was higher in group A (3.2% vs. 0% p = 0.269), and both were not significantly different. Overall morbidity and serious morbidity were higher in group B (7.5% vs. 5.9%, p = 0.626) and lower in group A (5.7% vs. 3.9%, p = 0.544), respectively, but were not significantly different. Operative time (mean, SD) was higher in group B (187 ± 107 vs. 138 ± 66 min, p < 0.001). However, the median (IQR) of hospital length of stay (LOS) was similar (2 [1, 4] vs. 2 [1, 3] days, p = 0.134). Conclusions: Overall, no difference was noted in the 30-day postoperative outcome between the two surgical approaches of CBT. However, operative time was longer when artery resection was performed. Further research to determine the factors predicting the need for carotid artery resection among patient gender is needed.","PeriodicalId":506240,"journal":{"name":"Surgeries","volume":"102 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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