The Evaluation of Cartilage Regeneration Efficacy of Three-Dimensionally Biofabricated Human-Derived Biomaterials on Knee Osteoarthritis: A Single-Arm, Open Label Study in Egypt.

Full thickness cartilage defects in cases of knee osteoarthritis are challenging in nature and are difficult to treat. The implantation of three-dimensional (3D) biofabricated grafts into the defect site can be a promising biological one-stage solution for such lesions that can avoid different disadvantages of the alternative surgical treatment options. In this study, the short-term clinical outcome of a novel surgical technique that uses a 3D bioprinted micronized adipose tissue (MAT) graft for knee cartilage defects is assessed and the degree of incorporation of such graft types is evaluated via arthroscopic and radiological analyses. Ten patients received 3D bioprinted grafts consisting of MAT with an allogenic hyaline cartilage matrix on a mold of polycaprolactone, with or without adjunct high tibial osteotomy, and they were monitored until 12 months postoperatively. Clinical outcomes were examined with patient-reported scoring instruments that consisted of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS). The graft incorporation was assessed using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. At 12 months follow-up, cartilage tissue biopsy samples were taken from patients and underwent histopathological examination. In the results, at final follow-up, the WOMAC and KOOS scores were 22.39 ± 7.7 and 79.16 ± 5.49, respectively. All scores were significantly increased at final follow-up (p < 0.0001). MOCART scores were also improved to a mean of 82.85 ± 11.49, 12 months after operation, and we observed a complete incorporation of the grafts with the surrounding cartilage. Together, this study suggests a novel regeneration technique for the treatment of knee osteoarthritis patients, with less rejection response and better efficacy.

Analysis of outcomes of endovascular embolisation: A cross-sectional two-center study on 46 visceral artery pseudoaneurysms.

PURPOSE: Visceral artery pseudoaneurysms (VAPAs) are uncommon in clinical practice but may have serious clinical outcomes up to death. Endovascular management is a safe effective alternative option to traditional surgical procedures. This study assesses the outcome of different embolic materials and techniques used in the endovascular management of VAPAs. MATERIALS AND METHODS: This is a two-center retrospective analysis of endovascular embolisation of 46 VAPAs, with a mean pseudoaneurysm size of 13 ± 11.35 mm, that were urgently managed between July 2018 and March 2020. Patients' presentations were GIT hemorrhage, intrabdominal hemorrhage, hematuria, and abdominal pain in 34.78%, 30.43%, 23.91%, and 10.87% respectively. Management using coils only was done in 28/46 patients (60.87%), NBCA glue only in 16/46 patients (34.78%), combined coils and NBCA glue in 1/46 patient (2.17%), and Amplatzer plugs only in 1 patient (2.17%). The management techniques were sac packing in 9/46 patients (19.57%), inflow occlusion in 28/46 patients (60.87%) and trapping in 9/46 patients (19.57%). All patients were followed-up for 1 year after the procedure. RESULTS: The overall clinical success and periprocedural complication rates were 93.48%, and 15.22% respectively, and 30-day mortality was zero. Clinical success was 92.86% in the coil subgroup (n = 28), and 93.75% in the NBCA glue subgroup (n = 16). The technical success rate was 100%. Effectiveness of the procedures during the follow-up was 97.83%. Target lesion re-intervention rate was 2.17%. CONCLUSION: Transarterial embolisation can provide high technical and clinical success rates with low periprocedural complication and re-intervention rates, as well as satisfactory procedure effectiveness in the management of VAPAs.

All types of component malrotation affect the early patient-reported outcome measures after total knee arthroplasty.

PURPOSE: Outcomes following total knee arthroplasty (TKA), whether clinical, radiological or survival analysis, have been well-studied. Still, there are some concerns about patient satisfaction with the outcome of the surgery and factors that might contribute to a suboptimal result. This study aims to determine if there is correlation between primary TKA malalignment and early patient-reported outcome measures (PROMs). MATERIALS AND METHODS: Sixty patients, who had primary TKA and a minimum of 2 years of follow up, were recruited for a detailed clinical and radiological examination. Knee alignment was measured in the coronal, sagittal and axial planes. Normal and the outlier measurements of the patients' knees were defined and the clinical results (PROMs) compared to see if there was a statistically significant difference. RESULTS: Correlation between postoperative limb malalignment in the coronal and the sagittal planes and PROMs was not significant. Conversely, there was significant negative correlation between all types of malrotation and PROMs. CONCLUSIONS: Although malalignment has been linked to inferior outcome and implant survival, our results showed that coronal and sagittal limb malalignment has no significant effect on early PROMs. However, all types of component rotational malalignment significantly worsen early PROMs.

Transcatheter arterial chemoembolization of hepatocellular carcinoma in patients with celiac axis occlusion using pancreaticoduodenal arcade as a challenging alternative route.

INTRODUCTION: Celiac axis occlusion is a challenging condition when catheterization of the hepatic artery is required for chemoembolization of hepatocellular carcinoma (HCC). As a result, the hepatic artery has to be catheterized through the pancreaticoduodenal arcades (PDA) and the gastroduodenal artery (GDA) from the superior mesenteric artery (SMA) which is a tortuous course with acute angles and small caliber branches. OBJECTIVE: To assess new techniques for facilitating catheterization of the tortuous PDA and the GDA to reach the proper hepatic artery (PHA) and tumor-feeding branches in patients with celiac axis occlusion undergoing chemoembolization of HCC. METHODS AND MATERIALS: The study included eleven patients all admitted to do transcatheter arterial chemoembolization (TACE) for treatment of unresectable HCC. During angiography occlusion of the celiac axis was diagnosed and hypertrophied PDA and GDA was noted in SMA angiography. Catheterization of the PDA was performed by preshaping of the micro-guide wire into a wide curve. Catheterization of the PHA was a challenge and was achieved by reshaping of the micro-guide wire or by looping technique. TACE was done after super selective catheterization of the tumor feeding artery using a mixture of 50 mg of adriamycin, 7cc of lipiodol and gelfoam. RESULTS: In the eleven patients with celiac artery occlusion, DSA showed complete celiac axis occlusion in all patients. Collateral arteries supplying the liver were readily evident via PDA and GDA from SMA. Successful catheterization of the PHA was achieved in all patients. Chemoembolization was performed to all patients after super selective catheterization of the feeding artery. Follow-up triphasic CT was performed in all patients, 9 patients showed good lipiodol trapping with no residual tumor enhancement. Two patients required another session of TACE. CONCLUSION: Chemoembolization of HCC through the PDA and the GDA using micro-guide wire preshaping technique and the microcatheter looping technique in patients with celiac axis occlusion is a challenging but effective treatment for HCC.

Repair of fistulae in-ano in children using image guided Histoacryl injection after failure of conservative treatment.

PURPOSE: Our aim is to determine the feasibility and safety of N Butyl Cyanoacrylate (HISTOACRYL), adhesive material in the treatment of fistula in-ano in infants and children. PATIENTS AND METHODS: 30 patients who presented with a perianal fistula (25 males and 5 females) were studied. Their ages ranged from 9 months to 15 years. All patients received medical (conservative) treatment. Six patients improved, 7 patients were subjected to surgical intervention, and the remaining 17 patients were managed by injection of adhesive material through the fistula under fluoroscopic guidance and general anesthesia after failure of medical management. RESULTS: Of the 17 children who underwent injection therapy to the fistula in-ano after failed medical management, 14 patients were males. The procedure time was 10 to 15 min. The mean follow up was 18 months. Two patients had a recurrence after one to two months. They were subjected to reinjection, and one of them had a second recurrence. Overall, 16 (94%) of 17 patients have had successful closure of their fistula, and one of them healed from a second injection. CONCLUSION: Our method of tissue adhesive Cyanoacrylate injection is safe, feasible, and can be used repeatedly in treatment of fistula in-ano in infants and children.

Preoperative embolization in surgical management of massive thoracic tumors.

BACKGROUND: The surgical excision of a highly vascular giant tumor may be challenging. The aim of this study was to describe our experience with preoperative percutaneous embolization of massive vascular chest tumors before surgical excision. METHODS: From 2009 to 2011, 8 cases of giant vascular thoracic tumor were treated at Assiut University Hospital, Assiut, Egypt, by preoperative embolization of the feeding arteries followed by successful excision after 48 h. RESULTS: The median age of the 8 patients was 39 years. Embolization of their tumors resulted in a reduction of tumor size, and minimal blood loss was observed perioperatively. Perilesional edema and easy differentiation of ischemic tissue facilitated complete surgical removal of the tumors. CONCLUSIONS: Preoperative embolization of giant vascular thoracic tumors is useful to decrease perioperative blood loss and facilitate total excision.

Supraumbilical pyloromyotomy: a comparative study between intracavitary and extracavitary techniques.

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of nonbilious vomiting in infancy, with an incidence of 1 to 3 per 1000 live births. Different approaches have been advocated for pyloromyotomy aiming to achieve better cosmetic results with least possible complications. Although many studies have shown that the umbilical pyloromyotomy is as safe as the traditional right upper quadrant approach with superior cosmetic results, still few studies reports high complication rates. The aim of this study was to assess intracavitary pyloromyotomy (ICP) in comparison with extracavitary pyloromyotomy (ECP) regarding the operative time, operative and postoperative complications, time to return to full oral feeding, and duration of hospital stay, as well as the final cosmetic results through supra umbilical skin incision. PATIENTS AND METHODS: Forty patients with IHPS were admitted to Assiut University Children Hospital from January 2008 to June 2010 and operated through supra umbilical incision. They were randomly divided according to the surgical technique into 2 groups: ECP group (20 patients) and ICP group (20 patients). The evaluating parameters were: pyloric muscle thickness, operative time, operative and postoperative complications, time to return to full oral feeding, duration of hospital stay, and final cosmetic results. RESULTS: There was no statistical significant difference between both groups regarding the patient's age, weight, pyloric muscle thickness, and duration of hospital stay. No mortality was encountered among all patients. There was a statistical significant difference between both groups regarding the mean operative time and time to return to full oral feeding. During the follow-up period (ranged from 6 weeks to 8 weeks) all patients were gaining weight satisfactorily and the scar was barely visible. CONCLUSIONS: ICP for pyloromyotomy is safe and can be done in large pyloric masses without wound extension. It gives best cosmetic results with minimal complications.