Background and Aims. Pan facial fractures are complex and often requiring complex airway management. Elective tracheostomy (ET) and submental endotracheal intubation (SEI) are the two major techniques for airway management. The aim of this article is to compare the management outcome between these techniques. Methods. This study was done in a tertiary care hospital from Jan 2019 to Dec 2019. Data were retrieved for all patients from hospital admission-discharge reports, operation room records, follow-up notes, and clinical photograph records which was recorded prospectively after ethical clearance. Total 38 patients were included in the study after the exclusion criteria into two groups: submental endotracheal intubation (SEI) and elective tracheostomy (ET). Demographic data, intraoperative time (IOT), length of hospital stay (LOHS), postoperative pain score at three and seven days, and Vancouver Scar Score (VSS) at 4 and 12 weeks was compared between the two groups. Results. SEI consisted of 23 patients (60%) while ET had 15 (40%) patients. The mean age was 32.77±8.24 years in the SEI and 29.36±7.32 years in the ET. The IOT in SEI was 15.36±1.53 min and 24.60±1.40 min in the ET which was statistically significant (p = 0.00001). The LOHS was 11±3.87 days in SEI and 25.2±3.88 days in ET (p = 0.0001). The mean VSS at 4 and 12 weeks for SEI were moderate and mild respectively and for the ET was moderate and mild respectively. Both were statistically significant with a p = 0.003 and p = 0.006. Conclusion. Submental intubation is a safe airway management technique in pan facial fracture. It provides the surgeon with an excellent operative field for achieving the proper dental occlusion. Both short- and long-term outcomes are better compared to the alternative airway method of elective tracheostomy.
{"title":"Airway Management in Pan Facial Fracture: An Outcome Analysis of Elective Tracheostomy and Submental Endotracheal Intubation","authors":"Vipin Venugopal Nair, Y. Issar, Harmanjot Singh Dhillon, Gurpinder Singh Ghotra, Pranay Pratap, Ayush Mathur, Kamalpreet Singh","doi":"10.15388/lietchirur.2024.23(1).9","DOIUrl":"https://doi.org/10.15388/lietchirur.2024.23(1).9","url":null,"abstract":"Background and Aims. Pan facial fractures are complex and often requiring complex airway management. Elective tracheostomy (ET) and submental endotracheal intubation (SEI) are the two major techniques for airway management. The aim of this article is to compare the management outcome between these techniques. Methods. This study was done in a tertiary care hospital from Jan 2019 to Dec 2019. Data were retrieved for all patients from hospital admission-discharge reports, operation room records, follow-up notes, and clinical photograph records which was recorded prospectively after ethical clearance. Total 38 patients were included in the study after the exclusion criteria into two groups: submental endotracheal intubation (SEI) and elective tracheostomy (ET). Demographic data, intraoperative time (IOT), length of hospital stay (LOHS), postoperative pain score at three and seven days, and Vancouver Scar Score (VSS) at 4 and 12 weeks was compared between the two groups. Results. SEI consisted of 23 patients (60%) while ET had 15 (40%) patients. The mean age was 32.77±8.24 years in the SEI and 29.36±7.32 years in the ET. The IOT in SEI was 15.36±1.53 min and 24.60±1.40 min in the ET which was statistically significant (p = 0.00001). The LOHS was 11±3.87 days in SEI and 25.2±3.88 days in ET (p = 0.0001). The mean VSS at 4 and 12 weeks for SEI were moderate and mild respectively and for the ET was moderate and mild respectively. Both were statistically significant with a p = 0.003 and p = 0.006. Conclusion. Submental intubation is a safe airway management technique in pan facial fracture. It provides the surgeon with an excellent operative field for achieving the proper dental occlusion. Both short- and long-term outcomes are better compared to the alternative airway method of elective tracheostomy.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"57 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140258642","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 : 2024-03-07DOI: 10.15388/lietchirur.2024.23(1).3
Mohammed Alfehaid
Background. Bedside teaching is an important tool in medical education. In recent years, studies have shown that this tool has witnessed gradual deterioration due to various reasons. Hence this pilot study was conducted to assess the students’ perspective about this tool and suggest remedies for the deficiencies. Methodology. An anonymous questionnaire was designed and students were requested to register the response offline. Data was analysed and inferences made. Results. Various deficiencies were highlighted by the students that require correction and improvement. Unavailability of suitable patients is a significant barrier. Communication skills and understanding of infection control protocols had got improved in 84% and 94% students respectively. Half of the students were fully satisfied or satisfied with the overall conduct of the bedside teaching and the other half were either partially satisfied or dissatisfied. Conclusion. There is a need to improve bedside teaching in Undergraduate Surgery course. Simulation sessions need to be devised and enhanced. Faculty development sessions to train the teachers are required.
{"title":"Bedside Teaching in Undergraduate Surgical Education: A Pilot Study of Students’ Perspective","authors":"Mohammed Alfehaid","doi":"10.15388/lietchirur.2024.23(1).3","DOIUrl":"https://doi.org/10.15388/lietchirur.2024.23(1).3","url":null,"abstract":"Background. Bedside teaching is an important tool in medical education. In recent years, studies have shown that this tool has witnessed gradual deterioration due to various reasons. Hence this pilot study was conducted to assess the students’ perspective about this tool and suggest remedies for the deficiencies. Methodology. An anonymous questionnaire was designed and students were requested to register the response offline. Data was analysed and inferences made. Results. Various deficiencies were highlighted by the students that require correction and improvement. Unavailability of suitable patients is a significant barrier. Communication skills and understanding of infection control protocols had got improved in 84% and 94% students respectively. Half of the students were fully satisfied or satisfied with the overall conduct of the bedside teaching and the other half were either partially satisfied or dissatisfied. Conclusion. There is a need to improve bedside teaching in Undergraduate Surgery course. Simulation sessions need to be devised and enhanced. Faculty development sessions to train the teachers are required.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"20 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140259901","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 : 2024-03-07DOI: 10.15388/lietchirur.2024.23(1).7
Swarup Prabhu, Ayjaz Hussain, Tarun Gupta
Necrotising fasciitis is a common surgical emergency. Risk factors include immunosuppression, type 2 diabetes mellitus, chronic diseases like cirrhosis of liver and chronic kidney disease, malignancies, intravenous drug use, obesity, and age more than 60 years. Our case is of a 14 years old boy who presented with necrotising fasciitis (NF) of right upper limb post varicella of 10 days duration. Prompt diagnosis with aggressive surgical debridement was lifesaving in this case. Early reconstruction with split skin grafting escalated recovery resulting in a fully functional limb without any residual deficit. This case is a rare example of post varicella NF in a young child without any co-morbidities. Majority such cases are encountered by a general surgeon in an emergency setting. Hence, this report sensitises and enlightens the first responders about the existence of this rare entity.
{"title":"Post Varicella Necrotising Fasciitis Afflicting Upper Limb in Young Child: A Rare Case Report","authors":"Swarup Prabhu, Ayjaz Hussain, Tarun Gupta","doi":"10.15388/lietchirur.2024.23(1).7","DOIUrl":"https://doi.org/10.15388/lietchirur.2024.23(1).7","url":null,"abstract":"Necrotising fasciitis is a common surgical emergency. Risk factors include immunosuppression, type 2 diabetes mellitus, chronic diseases like cirrhosis of liver and chronic kidney disease, malignancies, intravenous drug use, obesity, and age more than 60 years. Our case is of a 14 years old boy who presented with necrotising fasciitis (NF) of right upper limb post varicella of 10 days duration. Prompt diagnosis with aggressive surgical debridement was lifesaving in this case. Early reconstruction with split skin grafting escalated recovery resulting in a fully functional limb without any residual deficit. This case is a rare example of post varicella NF in a young child without any co-morbidities. Majority such cases are encountered by a general surgeon in an emergency setting. Hence, this report sensitises and enlightens the first responders about the existence of this rare entity.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"40 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140260613","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}
Iatrogenic tracheal rupture is very rare condition and has a lot off causes (intubation, tracheostomy, bronchoscopy, esophagectomy), but orotracheal intubation is the most common. Diagnosis is based on the occurrence of symptoms that are not specific but highly suggestive: subcutaneous emphysema, respiratory insufficiency, pneumothorax, and hemoptysis. The appearance of subcutaneous emphysema as a first sign plays a main role for early diagnosis and rapid appropriate treatment. Diagnostic confirmation is possible by chest X-ray, thoracic computed tomography and bronchoscopy which confirmed the size and site of the lesion. Treatment can be conservative, in patients with small ruptures, less than 2 cm, and surgical in the majority of ruptures over 2 cm in length. Our case report presents an iatrogenic post-intubation tracheal rupture treated conservatively. Our patient was a 71-year-old woman, admitted in our hospital with fracture of right humerus for elective surgery. Her medical history was only arterial hypertension. She underwent general anesthesia, intubated with flexible ET tube, positioned in beach-chair position after introduction, and no complication occurred during surgery. 18 hours after surgery, after severe coughing, she suddenly developed subcutaneous emphysema of the facial, neck and upper anterior chest. Tracheal rupture was confirmed with a thoracic computed tomography and tracheobronchial fiber endoscopy. It showed a posterior tracheal transmural rupture 1 cm long, located 4 cm above the carina, covered with small tissue that opened in inspirium. Conservative treatment with antibiotic cover was performed, and the patient was discharged home in good condition, fourteen days after the initial injury.
先天性气管破裂是一种非常罕见的疾病，有很多原因（插管、气管造口术、支气管镜检查、食管切除术），但最常见的是气管插管。诊断的依据是出现的症状，这些症状并不特异，但具有很强的提示性：皮下气肿、呼吸功能不全、气胸和咯血。皮下气肿作为首发症状的出现对早期诊断和快速适当治疗起着重要作用。胸部 X 光检查、胸部计算机断层扫描和支气管镜检查可确诊病变的大小和部位。对于小于 2 厘米的破裂患者，可采取保守治疗，而对于大多数长度超过 2 厘米的破裂患者，则可采取手术治疗。我们的病例报告介绍了一种保守治疗的先天性插管后气管破裂。患者是一名 71 岁的女性，因右肱骨骨折入院接受择期手术。她的病史只有动脉高血压。她接受了全身麻醉，插管时使用了柔性 ET 管，导入后取沙滩椅体位，术中未发生任何并发症。术后 18 小时，在剧烈咳嗽后，她的面部、颈部和前胸上部突然出现皮下气肿。胸部计算机断层扫描和气管支气管纤维内窥镜检查证实了气管破裂。结果显示，气管后部跨膜破裂长 1 厘米，位于心尖上方 4 厘米处，被小组织覆盖，吸气时裂口打开。患者在初次受伤 14 天后，接受了抗生素覆盖的保守治疗，情况良好，出院回家。
{"title":"Iatrogenic Tracheal Rupture after Endotracheal Intubation: A Case Report","authors":"Silvana Kraleva, Tatjana Trojikj, Darko Talevski, Dola Malefski, Gordana Bozinovska Beaka","doi":"10.15388/lietchirur.2024.23(1).6","DOIUrl":"https://doi.org/10.15388/lietchirur.2024.23(1).6","url":null,"abstract":"Iatrogenic tracheal rupture is very rare condition and has a lot off causes (intubation, tracheostomy, bronchoscopy, esophagectomy), but orotracheal intubation is the most common. Diagnosis is based on the occurrence of symptoms that are not specific but highly suggestive: subcutaneous emphysema, respiratory insufficiency, pneumothorax, and hemoptysis. The appearance of subcutaneous emphysema as a first sign plays a main role for early diagnosis and rapid appropriate treatment. Diagnostic confirmation is possible by chest X-ray, thoracic computed tomography and bronchoscopy which confirmed the size and site of the lesion. Treatment can be conservative, in patients with small ruptures, less than 2 cm, and surgical in the majority of ruptures over 2 cm in length. \u0000Our case report presents an iatrogenic post-intubation tracheal rupture treated conservatively. Our patient was a 71-year-old woman, admitted in our hospital with fracture of right humerus for elective surgery. Her medical history was only arterial hypertension. She underwent general anesthesia, intubated with flexible ET tube, positioned in beach-chair position after introduction, and no complication occurred during surgery. 18 hours after surgery, after severe coughing, she suddenly developed subcutaneous emphysema of the facial, neck and upper anterior chest. Tracheal rupture was confirmed with a thoracic computed tomography and tracheobronchial fiber endoscopy. It showed a posterior tracheal transmural rupture 1 cm long, located 4 cm above the carina, covered with small tissue that opened in inspirium. Conservative treatment with antibiotic cover was performed, and the patient was discharged home in good condition, fourteen days after the initial injury.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"31 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140077559","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 : 2023-11-29DOI: 10.15388/lietchirur.2023.22(4).2
Milda Paliulytė, Gytis Šustickas
Objectives. To assess characteristic data of patients hospitalized due to subacute subdural hematomas (SSDHs) and chronic subdural hematomas (CSDHs) and to evaluate radiological findings and establish predictors of hematoma recurrence of SSDHs and CSDHs patient populations. Methods. 149 patients with SSDHs and CSDHs who underwent surgery at Kaunas Clinics Neurosurgery Department from 2020 to 2021 were analyzed. Based on recurrence rate, patients were divided into different subtypes based on computer tomography (CT) imaging. Descriptive analysis, hypothesis testing and correlation matrix were performed using Excel spreadsheet and R programming language with the significance at p-value < 0.05. Results. Out of 149 patients, SSDHs and CSDHs were observed in 89 males (59.6%) and 60 (40.3%) females. Mean of the patients age was 71.1±15 years. Dichotomizing results based on recurrence (cut-off value of 25%), 2 groups were made: 1) low reoperation rate –hypodense sedimented (10%), isodense (21.6%), hypodense (22.2%); 2) high reoperation rate – hypodense bridging (26.7%), hypodense trabecular (27.8%), hypodense with acute bleeding (28.6%), hypodense laminar (30%), isodense with acute bleeding (33.3%). Conclusion. It is concluded that based on 25% reoperation rate high-recurrence and low-recurrence chronic subdural hematomas groups were similar in all terms apart from the hematoma thickness (mm), which leads to a fact that radiological appearance of higher recurrence hematomas should be carefully taken into consideration.
{"title":"Radiological and Clinical Prognostic Factors of Recurrence of Subacute and Chronic Subdural Hematomas","authors":"Milda Paliulytė, Gytis Šustickas","doi":"10.15388/lietchirur.2023.22(4).2","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22(4).2","url":null,"abstract":"Objectives. To assess characteristic data of patients hospitalized due to subacute subdural hematomas (SSDHs) and chronic subdural hematomas (CSDHs) and to evaluate radiological findings and establish predictors of hematoma recurrence of SSDHs and CSDHs patient populations. Methods. 149 patients with SSDHs and CSDHs who underwent surgery at Kaunas Clinics Neurosurgery Department from 2020 to 2021 were analyzed. Based on recurrence rate, patients were divided into different subtypes based on computer tomography (CT) imaging. Descriptive analysis, hypothesis testing and correlation matrix were performed using Excel spreadsheet and R programming language with the significance at p-value < 0.05. Results. Out of 149 patients, SSDHs and CSDHs were observed in 89 males (59.6%) and 60 (40.3%) females. Mean of the patients age was 71.1±15 years. Dichotomizing results based on recurrence (cut-off value of 25%), 2 groups were made: 1) low reoperation rate –hypodense sedimented (10%), isodense (21.6%), hypodense (22.2%); 2) high reoperation rate – hypodense bridging (26.7%), hypodense trabecular (27.8%), hypodense with acute bleeding (28.6%), hypodense laminar (30%), isodense with acute bleeding (33.3%). Conclusion. It is concluded that based on 25% reoperation rate high-recurrence and low-recurrence chronic subdural hematomas groups were similar in all terms apart from the hematoma thickness (mm), which leads to a fact that radiological appearance of higher recurrence hematomas should be carefully taken into consideration.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"137 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139210800","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}
Liver biopsy is the most accurate interventional procedure to diagnose hepatic diseases. According to the information provided by the Institute of Hygiene, 968 percutaneous liver biopsies were performed in Lithuania in 2022. The Lithuanian scientific literature does not, however, publish information on complications associated with this procedure. According to international literature, the frequency of complications after this procedure ranges from 2.4% to 9.5%. The most common are mild complications: hematomas, fever, pain at the biopsy site. Particularly rare are hemothorax, pneumothorax, damage to the organs of the thoracic and abdominal cavity, which occur in up to 0.04% of cases. This article presents an extremely rare complication – liver biopsy induced hemothorax, whose success was determined by early diagnosis and timely surgical intervention.
{"title":"Hemothorax Caused by Liver Biopsy – Rare Iatrogenic Complication","authors":"Diana Samiatina-Morkūnienė, Rūta Silickytė, Gabija Jankauskaitė","doi":"10.15388/lietchirur.2023.22(4).7","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22(4).7","url":null,"abstract":"Liver biopsy is the most accurate interventional procedure to diagnose hepatic diseases. According to the information provided by the Institute of Hygiene, 968 percutaneous liver biopsies were performed in Lithuania in 2022. The Lithuanian scientific literature does not, however, publish information on complications associated with this procedure. According to international literature, the frequency of complications after this procedure ranges from 2.4% to 9.5%. The most common are mild complications: hematomas, fever, pain at the biopsy site. Particularly rare are hemothorax, pneumothorax, damage to the organs of the thoracic and abdominal cavity, which occur in up to 0.04% of cases. This article presents an extremely rare complication – liver biopsy induced hemothorax, whose success was determined by early diagnosis and timely surgical intervention.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139210999","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 : 2023-11-29DOI: 10.15388/lietchirur.2023.22(4).1
Dovydas Rapolis, Matas Urmanavičius, A. Makulavičius, V. Uvarovas
Introduction. Hallux Rigidus, a degenerative disease of the first metatarsophalangeal joint (MTP), causes pain during movement, reduces joint mobility, and impairs quality of life. Conservative treatment methods are effective only in the early stages of the disease, and surgical treatment is usually recommended for advanced pathology. Arthrodesis procedure is the gold standard. This surgery effectively and relatively quickly reduces painful symptoms but sacrifices joint mobility. An alternative is resection arthroplasty. There is no consensus in the literature regarding the long-term outcomes of these two treatment methods. The aim of this study is to determine which method is superior in improving patients’ quality of life and foot function. Methods. A retrospective observational study was conducted on 41 patients who were followed up for 2–4 years after surgery. Of these, 20 underwent resection arthroplasty, 21 – arthrodesis. Patients’ quality of life and subjective foot function were assessed using two standardized questionnaires: SEFAS and Short Form-12. Additional questions on patient satisfaction with the surgery were also evaluated. Results. Patient satisfaction with the surgery was high in both groups (80%). There were no statistically significant differences in patients’ ankle and foot function assessed by SEFAS scale and psychological quality of life assessed by SF 12 (Mental Score): p = 0.14 and p = 0.729, respectively. Patients rated their physical quality of life significantly better, assessed by SF 12 (Physical Score), after undergoing arthroplasty (p = 0.02), and foot function recovered approximately 1 month faster compared to arthrodesis (p = 0.006). There were no cases of revision surgery, infectious complications, or non-unions in either group. Conclusions. Both surgical techniques are effective and improve patients’ functional status, but subjective foot function is better in the early postoperative period after resection arthroplasty. The majority of patients in both groups would recommend the surgery under similar circumstances.
简介拇趾外翻（Hallux Rigidus）是第一跖趾关节（MTP）的一种退行性疾病，会导致活动时疼痛，降低关节活动度，影响生活质量。保守治疗方法仅在疾病早期有效，晚期病变通常建议采用手术治疗。关节置换术是金标准。这种手术能有效且相对快速地减轻疼痛症状，但会牺牲关节的活动度。另一种方法是切除关节成形术。关于这两种治疗方法的长期疗效，文献尚未达成共识。本研究的目的是确定哪种方法能更好地改善患者的生活质量和足部功能。研究方法对手术后随访 2-4 年的 41 名患者进行了回顾性观察研究。其中 20 人接受了切除关节成形术，21 人接受了关节固定术。研究人员使用两种标准化问卷对患者的生活质量和主观足部功能进行了评估：SEFAS 和 Short Form-12。此外，还评估了患者对手术满意度的其他问题。结果。两组患者对手术的满意度都很高（80%）。根据 SEFAS 量表评估的患者踝关节和足部功能以及根据 SF 12（心理评分）评估的患者心理生活质量在统计学上没有明显差异：分别为 p = 0.14 和 p = 0.729。根据SF 12（身体评分）评估，接受关节置换术后患者的身体生活质量明显提高（p = 0.02），与关节置换术相比，足部功能恢复快约1个月（p = 0.006）。两组患者均未出现翻修手术、感染性并发症或不连接的情况。结论。两种手术方法都能有效改善患者的功能状况，但切除关节置换术术后早期的主观足部功能更好。在类似情况下，两组中的大多数患者都会推荐手术。
{"title":"Surgical treatment of Hallux Rigidus – arthrodesis or resection arthroplasty? Retrospective observational study","authors":"Dovydas Rapolis, Matas Urmanavičius, A. Makulavičius, V. Uvarovas","doi":"10.15388/lietchirur.2023.22(4).1","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22(4).1","url":null,"abstract":"Introduction. Hallux Rigidus, a degenerative disease of the first metatarsophalangeal joint (MTP), causes pain during movement, reduces joint mobility, and impairs quality of life. Conservative treatment methods are effective only in the early stages of the disease, and surgical treatment is usually recommended for advanced pathology. Arthrodesis procedure is the gold standard. This surgery effectively and relatively quickly reduces painful symptoms but sacrifices joint mobility. An alternative is resection arthroplasty. There is no consensus in the literature regarding the long-term outcomes of these two treatment methods. The aim of this study is to determine which method is superior in improving patients’ quality of life and foot function. Methods. A retrospective observational study was conducted on 41 patients who were followed up for 2–4 years after surgery. Of these, 20 underwent resection arthroplasty, 21 – arthrodesis. Patients’ quality of life and subjective foot function were assessed using two standardized questionnaires: SEFAS and Short Form-12. Additional questions on patient satisfaction with the surgery were also evaluated. Results. Patient satisfaction with the surgery was high in both groups (80%). There were no statistically significant differences in patients’ ankle and foot function assessed by SEFAS scale and psychological quality of life assessed by SF 12 (Mental Score): p = 0.14 and p = 0.729, respectively. Patients rated their physical quality of life significantly better, assessed by SF 12 (Physical Score), after undergoing arthroplasty (p = 0.02), and foot function recovered approximately 1 month faster compared to arthrodesis (p = 0.006). There were no cases of revision surgery, infectious complications, or non-unions in either group. Conclusions. Both surgical techniques are effective and improve patients’ functional status, but subjective foot function is better in the early postoperative period after resection arthroplasty. The majority of patients in both groups would recommend the surgery under similar circumstances.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139211445","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 : 2023-11-29DOI: 10.15388/lietchirur.2023.22(4).4
Aurimas Dobilinskas, Saulius Knystautas, Kęstutis Braziulis, Irmantas Rutkauskas, L. Pilipaitytė
Background. Carpal tunnel syndrome is the most common and widespread peripheral neuropathy in the world. The diagnostic testing methods for the carpal tunnel syndrome are based on anamnesis data, objective and instrumental inspection. Electroneuromyography is the main instrumental test when carpal tunnel syndrome is suspected. An ultrasound imaging may also be performed. Objective. To determine the effectiveness, sensitivity and specificity of instrumental diagnostics methods used to diagnose the carpal tunnel syndrome, and to compare them. Methods. Diagnostic testing – ultrasound and electroneuromyography was applied to persons under study. The area of the median nerve (mm2) was assessed during the ultrasound examination. The results of the electroneuromyography study evaluated the response speed of the sensory impulse (ms), the speed of the motor impulse response (ms). Later, the tests, their sensitivity and specificity were evaluated and compared. Results. 30 patients participated in the study, of which 26 (86.7%) were women, 4 (13.3%) were men. Electroneuromyography was found to be both sensitive and specific for a measure of sensory propagation velocity, 76.2 and 75%, respectively (p = 0.042); of motor propagation speed – 100 and 75% (p = 0.040). Ultrasonography is sensitive (87.5%) but nonspecific (66.7%) (p = 0.008). The study showed that the ultrasound dimension strongly, directly and reliably correlates with the sensory impulse response rate (p < 0.001), and the ultrasound dimension moderately, directly and reliably correlates with the motor impulse response rate (p < 0.001). Conclusions. Carpal tunnel syndrome can be suspected by ultrasound measurement of the area of the median nerve, but the test is only sensitive but non-specific. Electroneuromyography can confirm the diagnosis of carpal tunnel syndrome, as the test is both sensitive and specific. Comparing the studies, a strong, direct and reliable relationship between the results of the ultrasound and the electroneuromyography testing was established.
{"title":"Comparison of the Methods for Diagnosing the Carpal Tunnel Syndrome","authors":"Aurimas Dobilinskas, Saulius Knystautas, Kęstutis Braziulis, Irmantas Rutkauskas, L. Pilipaitytė","doi":"10.15388/lietchirur.2023.22(4).4","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22(4).4","url":null,"abstract":"Background. Carpal tunnel syndrome is the most common and widespread peripheral neuropathy in the world. The diagnostic testing methods for the carpal tunnel syndrome are based on anamnesis data, objective and instrumental inspection. Electroneuromyography is the main instrumental test when carpal tunnel syndrome is suspected. An ultrasound imaging may also be performed. Objective. To determine the effectiveness, sensitivity and specificity of instrumental diagnostics methods used to diagnose the carpal tunnel syndrome, and to compare them. Methods. Diagnostic testing – ultrasound and electroneuromyography was applied to persons under study. The area of the median nerve (mm2) was assessed during the ultrasound examination. The results of the electroneuromyography study evaluated the response speed of the sensory impulse (ms), the speed of the motor impulse response (ms). Later, the tests, their sensitivity and specificity were evaluated and compared. Results. 30 patients participated in the study, of which 26 (86.7%) were women, 4 (13.3%) were men. Electroneuromyography was found to be both sensitive and specific for a measure of sensory propagation velocity, 76.2 and 75%, respectively (p = 0.042); of motor propagation speed – 100 and 75% (p = 0.040). Ultrasonography is sensitive (87.5%) but nonspecific (66.7%) (p = 0.008). The study showed that the ultrasound dimension strongly, directly and reliably correlates with the sensory impulse response rate (p < 0.001), and the ultrasound dimension moderately, directly and reliably correlates with the motor impulse response rate (p < 0.001). Conclusions. Carpal tunnel syndrome can be suspected by ultrasound measurement of the area of the median nerve, but the test is only sensitive but non-specific. Electroneuromyography can confirm the diagnosis of carpal tunnel syndrome, as the test is both sensitive and specific. Comparing the studies, a strong, direct and reliable relationship between the results of the ultrasound and the electroneuromyography testing was established.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139211784","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}
Even in countries like India where the general dictum is to consider Tuberculosis as one of the differential diagnosis to any condition that is still under evaluation. Parotid Tuberculosis is a very rare entity. There are fewer than 200 cases reported in literature worldwide of Parotid gland Tuberculosis, a form of extrapulmonary Tuberculosis. We present an interesting case of Parotid Tuberculosis which presented as unilateral swelling in the parotid region of a four-year-old male child with an underlying abscess.
{"title":"A Rare Case of Parotid Tuberculosis in a Pediatric Patient: A Case Report","authors":"Aditya Pawar, Niranjan Sahoo, Pawan Sharma, Nidhi Rathi","doi":"10.15388/lietchirur.2023.22(4).5","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22(4).5","url":null,"abstract":"Even in countries like India where the general dictum is to consider Tuberculosis as one of the differential diagnosis to any condition that is still under evaluation. Parotid Tuberculosis is a very rare entity. There are fewer than 200 cases reported in literature worldwide of Parotid gland Tuberculosis, a form of extrapulmonary Tuberculosis. We present an interesting case of Parotid Tuberculosis which presented as unilateral swelling in the parotid region of a four-year-old male child with an underlying abscess.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"29 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139213865","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 : 2023-11-29DOI: 10.15388/lietchirur.2023.22(4).3
Eglė Virbickaitė, Emilija Dedelytė, Saulius Knystautas, Simas Gindriūnas, Kęstutis Braziulis
Background. Cubital tunnel syndrome is the second most commonly diagnosed compressive neuropathy of the upper extremity after carpal tunnel syndrome and the most common neuropathy of the ulnar nerve. Objective. To evaluate the results of surgical treatment of patients with cubital tunnel syndrome by performing an open decompression in situ. Methods. All subjects underwent a standard operation – open surgical opening of the elbow canal (decompression in situ). On the day of surgery, after 3 months, after 6 months, pain (verbal pain scale), hand and arm function (QuickDASH), complications are evaluated. Results. There were 44 patients, 16 (36%) female, 28 (64%) male. In 50% of the patients, electroneuromyography revealed a severe degree of ulnar nerve damage, in the rest – a moderate degree of damage. Hand function for women 3 months after surgery improved by 42.046 points (according to QuickDASH), while in men it was 15.454 points (p < 0.05). Meanwhile, hand function for woman 3 months after surgery improved by 45.833 points, while in men it was 20.000 points (p < 0.05). Statistically significant differences between the groups with a moderate and severe degree of damage were found only when assessing pain according to the VAS scale at 3 months after surgery (mean VAS scores 1.2 and 2.8 respectively). A positive correlation was also observed between age and improvement in hand function between 3–6 months after surgery (p < 0.05). In older people, improvement in hand function is observed after a longer period of time after surgery, and a more pronounced improvement in hand function with a severe degree of damage (comparing function before surgery and 6 months after surgery) is experienced by younger people. Conclusions. In situ decompression of the ulnar nerve is one of the most effective methods of treating ulnar neuropathy. With this method an improvement in the function of the hand and a decrease in pain are observed.
{"title":"Alkūnės kanalo sindromo chirurginio gydymo rezultatai","authors":"Eglė Virbickaitė, Emilija Dedelytė, Saulius Knystautas, Simas Gindriūnas, Kęstutis Braziulis","doi":"10.15388/lietchirur.2023.22(4).3","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22(4).3","url":null,"abstract":"Background. Cubital tunnel syndrome is the second most commonly diagnosed compressive neuropathy of the upper extremity after carpal tunnel syndrome and the most common neuropathy of the ulnar nerve. Objective. To evaluate the results of surgical treatment of patients with cubital tunnel syndrome by performing an open decompression in situ. Methods. All subjects underwent a standard operation – open surgical opening of the elbow canal (decompression in situ). On the day of surgery, after 3 months, after 6 months, pain (verbal pain scale), hand and arm function (QuickDASH), complications are evaluated. Results. There were 44 patients, 16 (36%) female, 28 (64%) male. In 50% of the patients, electroneuromyography revealed a severe degree of ulnar nerve damage, in the rest – a moderate degree of damage. Hand function for women 3 months after surgery improved by 42.046 points (according to QuickDASH), while in men it was 15.454 points (p < 0.05). Meanwhile, hand function for woman 3 months after surgery improved by 45.833 points, while in men it was 20.000 points (p < 0.05). Statistically significant differences between the groups with a moderate and severe degree of damage were found only when assessing pain according to the VAS scale at 3 months after surgery (mean VAS scores 1.2 and 2.8 respectively). A positive correlation was also observed between age and improvement in hand function between 3–6 months after surgery (p < 0.05). In older people, improvement in hand function is observed after a longer period of time after surgery, and a more pronounced improvement in hand function with a severe degree of damage (comparing function before surgery and 6 months after surgery) is experienced by younger people. Conclusions. In situ decompression of the ulnar nerve is one of the most effective methods of treating ulnar neuropathy. With this method an improvement in the function of the hand and a decrease in pain are observed.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139214600","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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