Modified versus Classical Tubularised Incised Plate Urethroplasty in Hypospadias: A Comparative Study.

BACKGROUND: Hypospadias is a wide-world congenital malformation that accounts for 1 of 300 live male births. Many procedures were considered for its management. As the tubularised incised plate (TIP) urethroplasty, the most prevalent technique, caused many complications, several modifications were applied to the original operation to improve the outcomes and alleviate complications. The aim of this study was to compare the outcome of the ordinary TIP urethroplasty with the technique modified without dissection of the glans penis. MATERIALS AND METHODS: A total of 82 patients with a mean age of 18.8 (±14.8) months, were randomly assigned to undergo TIP with either complete glans wings mobilisation (Group A, n = 42 patients) or without glans dissection (Group B, n = 40 patients). To evaluate the effect of modified TIP urethroplasty without glanular dissection for treatment of distal hypospadias in contrast to classical TIP repair. RESULTS: Both techniques showed similar outcomes regarding functional repair, with good to excellent results between 88% and 90% after 6 months of follow-up. Most confronted post-operative complications were wound infection, oedema, urethrocutaneous fistulas and meatal stenosis. Less frequently haematoma, post-operative bleeding and glans dehiscence were encountered. The differences in complication rates between the two studied groups were statistically insignificant except for oedema (P = 0.04), and need for urethral dilatation (P = 0.002) that were more prevalent among patients who were treated with classic TIP repair with complete glans wings mobilisation. CONCLUSION: From our point of view, it seems that TIP without glanular dissection technique does not outweigh TIP with complete glans wings mobilisation regarding functional outcomes and post-operative complications.

[Ultrasound-guided percutaneous thermal ablation assisted by artificial ascites and soft tissue edema in the treatment of special-region hepatic tumors].

Objective: To explore the application value and operation skills of ultrasound-guided percutaneous thermal ablation assisted by artificial ascites or/and soft tissue edema in the treatment of special hepatic tumors located nearby the diaphragm, heart, stomach, gastrointestinal tract, gall bladder, kidney, and other organs. Methods: The clinical data of 132 patients with special-region hepatic tumors treated with ultrasound-guided percutaneous thermal ablation aided by artificial ascites and/or artificial soft tissue edema were retrospectively analyzed. Intraoperative contrast-enhanced ultrasound was used to guide ablation when necessary. During the operation, the ablation needle was lifted or pressed down, or the direction of the needle handle was changed to protect vital organs. The technical success rate of artificial ascites and/or soft tissue edema formation, the complete in activation rate of the tumor, and the complications were observed. Results: There were 74 patients (108 lesions) treated with radiofrequency ablation and 58 patients (82 lesions) treated with microwave ablation. Among them, 81 cases was successfully injected artificial abdominal ascites, with a water volume of (1 301±685) ml; artificial soft tissue edema was successfully formed for 19 patients, with a water volume of (534±258) ml. Both artificial ascites and artificial soft tissue edema were built for 30 patients. The success rate of this hydro-isolation technique was 98.5% (130/132). 129 patients successfully completed the treatment, and the complete inactivation rate of the tumor was 92.5% (172/186). The average postoperative hospital stay was three days. No patient had serious complications, such as surface tumor rupture, gastrointestinal injury, or diaphragm perforation. Conclusions: For hepatic tumors located adjacent to other organs such as the diaphragm, heart, gastrointestinal tract, gallbladder, and kidney, the application of artificial ascites and/or artificial soft tissue edema can reduce the damage to these organs, as well as reduce the possibility of tumor rupture and diaphragm perforation. These methods are safe and effective in ultrasound-guided percutaneous thermal ablation.

Evaluating the complications of adult groin hernia where there is no hernia registry: a systematic review of Nigerian literature.

BACKGROUND: Enumerating the complications of groin hernia repair might help to highlight the need for improvement in the quality of care. This is imperative in a country without a strong post-operative complication surveillance mechanism. Hence, this review aims to determine the complications encountered during the surgical treatment of groin hernias among Nigerian subjects. METHODS: Databases like Google Scholar, Scopus, and PubMed were searched. Out of the 140 papers found during the search, only 20 were included in this review. Bassini repair was the most common type of hernia repair used, and neither laparoscopic repair nor posterior approach was utilized in any of the patients. Emergency presentations constituted about 18.5% of the cases. Meta-analysis of the studies showed that more prevalent complications were wound/scrotal edema (derived from four studies), surgical site infections (derived from 17 studies), and hematoma (from 19 studies). The rates were 23% (CI 0-46%; I2 = 80.9%), 6% (CI 3-10%; I2 = 87.7%), and 5% (CI 2-8%; I2 = 83.7%), respectively. The rate of complication in giant hernias was higher than the non-giant hernias and was statistically significant [p < 0.05; OR 1.5 (CI 0.9-2.4)]. Although the recurrence rate is low, there was insufficient follow-up of patients. CONCLUSION: This review has shown that one-fifth of the patients had emergency repair of hernias and giant groin hernias have higher odds of complications after repair compared to normal-sized ones. The most common complication noted was wound/scrotal edema. None of the hernias was repaired with laparoscopy. Perhaps, establishing a registry might improve the detection of late complications in patients who had groin hernia repair.

Effects of endoluminal vacuum sponge therapy on the perfusion of gastric conduit in a porcine model for esophagectomy.

BACKGROUND: After esophagectomy, the postoperative rate of anastomotic leakage is up to 30% and is the main driver of postoperative morbidity. Contemporary management includes endoluminal vacuum sponge therapy (EndoVAC) with good success rates. Vacuum therapy improves tissue perfusion in superficial wounds, but this has not been shown for gastric conduits. This study aimed to assess gastric conduit perfusion with EndoVAC in a porcine model for esophagectomy. MATERIAL AND METHODS: A porcine model (n = 18) was used with gastric conduit formation and induction of ischemia at the cranial end of the gastric conduit with measurement of tissue perfusion over time. In three experimental groups EndoVAC therapy was then used in the gastric conduit (- 40, - 125, and - 200 mmHg). Changes in tissue perfusion and tissue edema were assessed using hyperspectral imaging. The study was approved by local authorities (Project License G-333/19, G-67/22). RESULTS: Induction of ischemia led to significant reduction of tissue oxygenation from 65.1 ± 2.5% to 44.7 ± 5.5% (p < 0.01). After EndoVAC therapy with - 125 mmHg a significant increase in tissue oxygenation to 61.9 ± 5.5% was seen after 60 min and stayed stable after 120 min (62.9 ± 9.4%, p < 0.01 vs tissue ischemia). A similar improvement was seen with EndoVAC therapy at - 200 mmHg. A nonsignificant increase in oxygenation levels was also seen after therapy with - 40 mmHg, from 46.3 ± 3.4% to 52.5 ± 4.3% and 53.9 ± 8.1% after 60 and 120 min respectively (p > 0.05). An increase in tissue edema was observed after 60 and 120 min of EndoVAC therapy with - 200 mmHg but not with - 40 and - 125 mmHg. CONCLUSIONS: EndoVAC therapy with a pressure of - 125 mmHg significantly increased tissue perfusion of ischemic gastric conduit. With better understanding of underlying physiology the optimal use of EndoVAC therapy can be determined including a possible preemptive use for gastric conduits with impaired arterial perfusion or venous congestion.

Multi-institutional study of 'Sandwich treatment' for motor area large brain metastases (LBM) with diameter over 3 cm.

BACKGROUND: The objective of the present study was to explore the effectiveness and safety of 'Sandwich treatment' strategy for large brain metastases (LBM) with diameter over 3 cm (minimum volume >= 15 cm3) located in motor area. PATIENTS AND METHODS: Patients from four gamma knife center that received 'Sandwich treatment' were retrospectively studied from January 2016 to March 2023. The strategy was one-week treatment course including 2 stages of stereotactic radiosurgery (SRS) and using bevacizumab once during SRS gap. The tumor volume and peri-tumor edema changes were analyzed before and after 'Sandwich treatment'. Manual muscle testing (MMT) score and Barthel Index (BI) score were used to evaluate the changes of patients' movement and physical strength rehabilitation. The patients' overall survival (OS) and tumor local control (TLC) rate was calculated. Cox regression model was used to analyze the risk factors that related to TLC. RESULTS: 61 patients with 72 lesions received the 'Sandwich treatment'. The median prescription dose was 13.0 Gy and 12.5 Gy at the first- and second-stage SRS. The mean tumor volume at the time of 'Sandwich treatment' and 3 months later was 20.1 cm3 and 12.3, respectively (P < 0.01). The mean peri-tumor edema volume at the first- and second-stage SRS was 12.6 cm3 and 5.2 cm3, respectively (P < 0.01). Patients' median MMT score improved from 6 at the beginning to 8 at the end of 'Sandwich treatment' (P < 0.01), BI score was also greatly improved from 45 at the time of 'Sandwich treatment' to 95 after 3 months (P < 0.01). Patients' median OS was 14.0 months, and the 3, 6, 12 months OS rate was 92.0%, 86.0% and 66.0%, respectively. The TLC rate at 3, 6, 12 months was 98.4%, 93.4%, and 85.3%, respectively. Patients with lung cancer had lower risk of tumor relapse. The cumulative incidence of patient's hemorrhage and radiation necrosis was 4.92% (3/61) and 13.11% (8/61) after 'Sandwich treatment'. CONCLUSIONS: 'Sandwich treatment' strategy is safe and effective for LBM located in motor area. The strategy could rapidly improve the patients' movement and enhance their physical strength rehabilitation.

Effects of Orbicularis Oculi Flap Suspension on Transcutaneous Lower Blepharoplasty.

OBJECTIVE: The purpose of this study was to analyze the clinical effects of orbicularis oculi muscle suspension in conjunction with transcutaneous blepharoplasty in patients 60 years of age or older. METHODS: A retrospective study was conducted on patients aged 60 or older who underwent orbicularis oculi flap suspension in conjunction with transcutaneous blepharoplasty to treat lower lid festoons, lower lid fat prolapse, and lid laxity at Korea University Guro Hospital. The outcomes were surgical success rate, recurrence rate, postoperative complications, and patient satisfaction. RESULTS: In total, 39 patients (18 males and 21 females) were included, with an average age of 67.5 years (60-86 y) and a follow-up period of 145.7 days (95-195 d). In all patients, eyelid laxity was effectively corrected, and there was no recurrence of eyelid laxity after surgery. Three patients suffered postoperative complications, transient skin edema in 2 patients, and transient ectropion in 1 patient. Subjective satisfaction score following surgery was high, with an average score of 2.56 out of 3 points. CONCLUSIONS: Orbicularis oculi flap suspension with transcutaneous blepharoplasty can shorten operation time due to surgical ease. It also has the advantage of not involving conjunctival-related complications such as conjunctival edema since it does not pass through the conjunctiva. Finally, it can successfully treat lid laxity and could be used in lower blepharoplasty procedures.

Effect of Cobalt-60 Treatment Dose Rate on Arteriovenous Malformation Obliteration After Stereotactic Radiosurgery With Gamma Knife.

BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) marginal dose is associated with successful obliteration of cerebral arteriovenous malformations (AVM). SRS dose rate-how old the cobalt-60 sources are-is known to influence outcomes for some neurological conditions and benign tumors. The objective of this study was to determine the association between cobalt-60 treatment dose rate and cerebral AVM obliteration in patients treated with SRS. METHODS: We performed a retrospective cohort study of 361 patients undergoing 411 AVM-directed SRS treatments between 2005 and 2019 at a single institution. Lesion characteristics, SRS details, obliteration dates, and post-treatment toxicities were recorded. Univariate and multivariate regression analyses of AVM outcomes regarding SRS dose rate (range 1.3-3.7 Gy, mean = 2.4 Gy, median = 2.5 Gy) were performed. RESULTS: At 10 years post-SRS, 68% of AVMs were obliterated on follow-up imaging. Dose rates >2.9 Gy/min were found to be significantly associated with AVM obliteration compared with those <2.1 Gy/min ( P = .034). AVM size, biologically effective dose, and SRS marginal dose were also associated with obliteration, with obliteration more likely for smaller lesions, higher biologically effective dose, and higher marginal dose. Higher dose rates were not associated with the development of post-SRS radiological or symptomatic edema, although larger AVM volume was associated with both types of edema. CONCLUSION: Patients with cerebral AVMs treated with higher SRS dose rates (from newer cobalt-60 sources) experience higher incidences of obliteration without a significant change in the risk of post-treatment edema.

Effect of kinesio-taping on the acute phase of the post-operative reconstruction of the anterior cruciate ligament: A randomized controlled trial.

OBJECTIVES: Evaluate the Kinesio taping (KT) effects on reducing pain and edema on postoperative (PO) after anterior cruciate ligament (ACL) reconstruction. DESIGN: Controlled and randomized clinical study. SETTINGS: Individuals of both sexes, aged 18-45, underwent ACL reconstruction were randomized into intervention (IG; n = 19) and control (CG; n = 19) groups. METHODS: Intervention consisted of KT bandage applications at hospital discharge for seven days, and on the 7th PO day, which was removed on the 14th PO. CG received specific instructions from the physiotherapy service. All volunteers were evaluations before and immediately after surgery, on the 7th and 14th PO day. Pain threshold (KgF), evaluated by algometer; edema (cm), evaluated by the perimetry measurements and volume of the lower limbs and the truncated cone test (ml) were the evaluated variables. The Student's t-test and Mann-Whitney U test were used to evaluate intergroup, analysis of variance (ANOVA) and Dunnett's test to evaluate intragroup. RESULTS: Edema reduction and increased nociceptive threshold were significant in the 7th (p < 0.001; p = 0.003) and 14th (p < 0.001; p = 0.006) PO day in IG when compared to CG patients. IG perimetry levels, on the 7th and 14th PO were similar to preoperative period (p = 0.229; p = 1.000). IG nociceptive threshold value was similar on the 14th PO to before the surgery (p = 0.987). The same pattern did not occur in CG. CONCLUSION: KT treatment reduced edema and increased nociceptive threshold in the 7th and 14th PO ACL reconstruction.

Comparison of the Efficacy of Subosseous Window Neuro-Endoscopy and Minimally Invasive Craniotomy in the Treatment of Basal Ganglia Hypertensive Intracerebral Hemorrhage.

OBJECTIVE: To compare the perioperative indexes and long-term effects of craniotomy and neuro-endoscopic hematoma removal in patients with hypertensive intracerebral hemorrhage (HICH) in the basal ganglia region. METHODS: This study involved 128 patients with HICH in the basal ganglia region who were admitted to our hospital from February 2020 to June 2022. They were divided into 2 groups according to the random number table method. The craniotomy group (n = 70) underwent microsurgery with small bone window craniotomy with a side cleft, and the neuro-endoscopy group (n = 58) underwent small bone window neuro-endoscopic surgery. A 3-dimensional Slicer was used to calculate the hematoma volume and clearance rate and the postoperative brain tissue edema volume. The operation time, intraoperative blood loss, postoperative intracranial pressure, complications, mortality, and improvement in the modified Rankin scale score at 6 months postoperatively were compared between the two groups. RESULTS: The clearance rate was significantly higher in the neuro-endoscopy group than in the craniotomy group (94.16% ± 1.86% versus 90.87% ± 1.89%, P < 0.0001). The operation time was significantly lower in the neuro-endoscopy group than in the craniotomy group (89.9 ± 11.7 versus 203.7 ± 57.6 min, P < 0.0001). Intraoperative blood loss was significantly higher in the craniotomy group (248.31 ± 94.65 versus 78.66 ± 28.96 mL, P < 0.0001). The postoperative length of stay in the intensive care unit was 12.6 days in the neuro-endoscopy group and 14.0 days in the craniotomy group with no significant difference ( P = 0.196). Intracranial pressure monitoring showed no significant difference between the two groups on postoperative days 1 and 7. Intracranial pressure was significantly higher in the craniotomy group than in the neuro-endoscopy group on postoperative day 3 (15.1 ± 6.8 versus 12.5 ± 6.8 mm Hg, P = 0.029). There was no significant difference in the mortality or outcome rate at 6 months postoperatively between the two groups. CONCLUSIONS: In patients with HICH in the basal ganglia region, neuro-endoscopy can significantly improve the hematoma clearance rate, reduce intraoperative hemorrhage and postoperative cerebral tissue edema, and improve surgical efficiency. However, the long-term prognosis of patients who undergo craniotomy through the lateral fissure is similar to that of patients who undergo neuro-endoscopic surgery.

Comparison of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty in Keratoconic Eyes With Previous Hydrops-Related Corneal Scar.

PURPOSE: This study aimed to compare the outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) procedures in keratoconic eyes with a previous hydrops-related corneal scar. METHODS: In this retrospective study, the medical records of patients who had hydrops-related corneal scarring and underwent keratoplasty surgery were reviewed. Patients treated with DALK were classified as group 1, and patients treated with PK as group 2. Preoperative and postoperative best-corrected visual acuity, central corneal thickness, keratometry (K), and refractive error values of each group were recorded and compared. RESULTS: Seventy-eight eyes (41 in group 1 and 37 in group 2) were included in this study. The mean follow-up period of the patients was 37.7 ± 30.0 months in group 1 and 51.2 ± 29.4 months in group 2 ( P = 0.06). The preoperative and postoperative best-corrected visual acuity and central corneal thickness values were statistically similar in both groups (each P value >0.05). Keratometry values (K1 and mean keratometry) were significantly steeper in group 1 ( P1 = 0.02 and P2 = 0.03, respectively). Descemet membrane perforation was experienced in 7 (4 macroperforation and 3 microperforation; 15.6%) of 45 eyes that planned to perform DALK. These 4 eyes with macroperforation underwent PK and were excluded from the study. When all postoperative complications were assessed, although the total complication rate was 21% after DALK, it was 43% after PK ( P = 0.04). CONCLUSIONS: DALK with a big-bubble technique is a feasible surgery in eyes with corneal scarring due to previous hydrops and is comparable with PK in terms of visual and refractive outcomes. This study suggests that DALK, which is safer than PK with less postoperative complication rates, should be the primary surgical option to avoid serious complications in keratoconic eyes with hydrops-related corneal scarring.

Clinical and microbiological comparison of knotless/barbed and silk sutures for impacted third-molar surgery.

BACKGROUND: Several types of suture materials are available for oral surgery. However, the most used non-resorbable suture in oral surgery is 3/0 silk. The aim of the present study was to compare the effectiveness of knotless/barbed sutures with silk sutures during the postoperative period after the third molar surgery in terms of clinical and microbiological parameters. METHODS: The study comprised 38 patients who underwent surgical extraction of a mandibular impacted third molar. The patients were divided into two groups. The mucoperiosteal flap was closed using 3/0 knotless/barbed sutures for the test group and 3/0 silk sutures for the control group. The duration of suturing was recorded during surgery. Pain level, postoperative edema, and trismus were measured at 3 and 7 days after surgery. The status of plaque formation on the sutures was scored using the Plaque Index at 3 and 7 days after the surgery. At 7 days, the suture materials were removed and submitted to the laboratory for microbiological analysis. The level of pain during suture removal was also recorded by a Visual Analog Scale. RESULTS: The duration of suturing in the barbed sutures group was found significantly lower than in silk sutures (P<0.05). There was no significant difference between the suture types in terms of trismus and edema at 3 and 7 days after surgery (P>0.05). On the third day after surgery and during suture, removal pain scores were statistically significantly lower in the barbed suture group than in the silk suture group (P<0.05). The Plaque Index values of the barbed sutures were statistically significantly lower than that of the silk sutures at 3 and 7 days after surgery (P<0.05). Aerobic, anaerobic, and aerobic/anaerobic mean colony forming units (CFUs) were statistically significantly lower in the barbed suture group than in the silk suture group (P<0.05). CONCLUSIONS: Barbed sutures increase the ease of operation and patient comfort with less postoperative pain than silk sutures. Additionally, less plaque accumulation and lower bacterial colonization were found on the barbed/knotless sutures than on the silk sutures.

The pre-Descemet's layer (Dua's layer, also known as the Dua-Fine layer and the pre-posterior limiting lamina layer): Discovery, characterisation, clinical and surgical applications, and the controversy.

The pre-Descemet's layer/Dua's layer, also termed the Dua-Fine layer and the pre-posterior limiting lamina layer, lies anterior to the Descemet's membrane in the cornea, is 10 µm (range 6-16) thick, made predominantly of type I and some type VI collagen with abundant elastin, more than any other layer of the cornea. It has high tensile strength (bursting pressure up to 700 mm of Hg), is impervious to air and almost acellular. At the periphery it demonstrates fenestrations and ramifies to become the core of the trabecular meshwork, with implications for intraocular pressure and glaucoma. It has been demonstrated in some species of animals. The layer has assumed considerable importance in anterior and posterior lamellar corneal transplant surgery by improving our understanding of the behaviour of corneal tissue during these procedures, improved techniques and made the surgery safer with better outcomes. It has led to the innovation of new surgical procedures namely, pre-Descemet's endothelial keratoplasty, suture management of acute hydrops, DALK-triple and Fogla's mini DALK. The discovery and knowledge of the layer has introduced paradigm shifts in our age old concepts of Descemet's membrane detachment, acute corneal hydrops in keratoconus and Descemetoceles, with impact on management approaches. It has been shown to contribute to the pathology and clinical signs observed in corneal infections and some corneal dystrophies. Early evidence suggests that it may have a role in the pathogenesis of keratoconus in relation to its elastin content. Its contribution to corneal biomechanics and glaucoma are subjects of current investigations.

Streptococcus vestibularis atypical infectious keratits after intracorneal ring segment implantation.

PURPOSE: To report the first case of an atypical infectious keratitis caused by Streptococcus vestibularis after ICRS implantation. CASE REPORT: A 65-year-old man underwent intracorneal ring segments (ICRS) implantation for the treatment of a pellucid marginal corneal degeneration (PMCD) in his both eyes (OU). Three weeks after the surgery of the right eye (OD), the patient presented with pain, redness, and vision loss in his OD. BCVA was 20/100 Snellen equivalent in the OD. Slit-lamp examination revealed punctate whitish infiltrates along the ring segment with associated corneal stromal edema in the OD. Corneal scrapings were obtained for gram satins and bacterial and fungal cultures, and topical treatment with hourly ciprofloxacin was started. Two days later, corneal stromal edema worsened with involvement of the ring channel. Thus, the ring segment was removed and sent for cultures, and the ring channel was irrigated with vancomycin. Culture from ring segment came back positive for Streptococcus vestibularis, so topical targeted antiobiotherapy with vancomycin and erythromycin was applied. At 3 weeks of follow-up, BCVA was of 20/40 Snellen equivalent in the OD and a subtle corneal leucoma in the OD was observed in the slit-lamp examination. CONCLUSION: Although infectious keratitis is a rare and serious disorder associated with ICRS implantation, its early recognition and management is essential in order to avoid sight-threatening complications. Thus, a prompt obtainment of corneal curettage samples and removal of ring segment becomes decisive to initiate a targeted antiobiotherapy.

Deep Learning Model for the Detection of Corneal Edema Before Descemet Membrane Endothelial Keratoplasty on Optical Coherence Tomography Images.

Purpose: Descemet membrane endothelial keratoplasty (DMEK) is the preferred method for treating corneal endothelial dysfunction, such as Fuchs endothelial corneal dystrophy (FECD). The surgical indication is based on the patients' symptoms and the presence of corneal edema. We developed an automated tool based on deep learning to detect edema in corneal optical coherence tomography images. This study aimed to evaluate this approach in edema detection before Descemet membrane endothelial keratoplasty surgery, for patients with or without FECD. Methods: We used our previously described model allowing to classify each pixel in the corneal optical coherence tomography images as "normal" or "edema." We included 1992 images of normal and preoperative edematous corneas. We calculated the edema fraction (EF), defined as the ratio between the number of pixels labeled as "edema," and those representing the cornea for each patient. Differential central corneal thickness (DCCT), defined as the difference in central corneal thickness before and 6 months after surgery, was used to quantify preoperative edema. AUC of EF for the edema detection was calculated for Several DCCT thresholds and a value of 20 µm was selected to define significant edema as it provided the highest area under the curve value. Results: The area under the curve of the receiver operating characteristic curve for EF for the detection of 20 µm of DCCT was 0.97 for all patients, 0.96 for Fuchs and normal only and 0.99 for non-FECD and normal patients. The optimal EF threshold was 0.143 for all patients and patients with FECD. Conclusions: Our model is capable of objectively detecting minimal corneal edema before Descemet membrane endothelial keratoplasty surgery. Translational Relevance: Deep learning can help to interpret optical coherence tomography scans and aid the surgeon in decision-making.

Swelling assessment after total knee arthroplasty.

BACKGROUND: Total knee arthroplasty is a commonly performed elective orthopaedic surgery. Patients may endure substantial knee swelling following surgery, which are attributable to both effusion and edema. Studies have been aiming to identify an accurate and reliable method to quantify post-operative knee swelling to aid monitoring progress and treatment. The aim of this article was to review the means of clinically applicable measurements for knee swelling post TKA. METHODS: The medical literature was searched using PubMed to search for articles published using the terms knee edema, effusion, swelling, knee arthroplasty, knee replacement, total knee arthroplasty, total knee replacement, TKA, TKR. Year of publication was not restricted. Only English language publications were included. Only full-text published articles from peer-reviewed journals were eligible for inclusion. The knee swelling measurement methods used in post TKA were reviewed. RESULTS: Advancement in bioimpedance spectroscopy and handheld 3D scanning technology allows quick and precise quantification of knee swelling volume that the traditional clinical circumferential measurement and volumetric measurement lack. Handheld 3D scanning is also a potential tool to estimate the change of knee effusion volume and muscular volume after the surgery. Magnetic resonance imaging is accurate in effusion measurement but also the most time and resource demanding method. CONCLUSION: Bioimpedance spectroscopy and 3D scanning technology can be the future tools for clinically measurement of knee swelling after total knee arthroplasty.

Unsedated Office-Based Thulium Laser Therapy in Patients With Reinke's Edema.

OBJECTIVE: To report the outcome of unsedated office based Thulium laser therapy for Reinke's edema. MATERIALS AND METHODS: A retrospective chart review of patients operated between March 2017 and November 2018 was conducted. Twelve patients were included, two of whom had two procedures performed. Demographic data included age, gender, smoking status, and grade of Reinke's edema. Outcome measures included Voice Handicap Index-10 (VHI), perceptual evaluation, extent of disease regression, acoustic analysis, and maximal phonation time. RESULTS: Twelve patients were enrolled in this study, one of whom was lost for follow-up. There were eight females and three males. The mean age was 51.27 ± 9.12 years. Endoscopic evaluation 6-12 weeks after surgery revealed complete and partial regression of disease in three and eight patients, respectively. There was a significant improvement in the mean score of VHI-10 (15.00 ± 9.45 vs 3.07 ± 3.81) and the mean score of GRABS parameters following surgery (P < 0.05). The mean habitual pitch increased from 125.11 ± 28.48 Hz to 155.86 ± 55.14 Hz (P = 0.070). There was improvement in the mean jitter and shimmer but none reached a statistical significance. There was no significant change in the mean Maximum phonation time (MPT) scores before and after surgery. CONCLUSION: Unsedated office-based Thulium laser therapy can be considered as an alternative therapy to patients with Reinke's edema who are not willing to undergo conventional microlaryngeal surgery.

Risk of Acute Lung Injury after Esophagectomy.

To develop a new approach for identifying acute lung injury (ALI) in surgical ward setting and to assess incidence rate, clinical outcomes, and risk factors for ALI cases after esophagectomy. We also compare the degree of lung injury between operative and non-operative sides. Consecutive esophageal cancer patients (n=1022) who underwent esophagectomy from Dec 2012 to Nov 2018 in our hospital were studied. An approach for identifying ALI was proposed that integrated radiographic assessment of lung edema (RALE) score to quantify degree of lung edema. Stepwise logistic regression identified risk factors for postoperative ALI incidence. The degree of bilateral lung injury was compared using the RALE score. The approach for identifying ALI in surgical ward setting was defined as acute onset, PaO2/FiO2≤300 mmHg, bilateral opacities on bedside chest radiograph with a RALE score≥16, and exclusion of cardiogenic pulmonary edema. Incidence rate of ALI was estimated to be 9.7%. ALI diagnosis was associated with multiple clinical complications, prolonged hospital stay, higher medical bills, and higher perioperative mortality. Nine risk factors including BMI, ASA class, DLCO%, duration of surgery, neutrophil percentage, high-density lipoprotein, and electrolyte disorders were identified. The RALE score of the lung lobes of the operative side was higher than the non-operative side. A new approach for identifying ALI in esophageal cancer patients receiving esophagectomy was proposed and several risk factors were identified. ALI is common and has severe outcomes. The lung lobes on the operative side are more likely to be affected than the non-operative side.

Effects of Temperature and Volume of Intraoperative Normal Saline Irrigation on Postoperative Pain, Swelling, and Serum Markers of Inflammation in Patients After Elective, Arthroscopic, Single-Bundle Surgical Reconstruction of the Anterior Cruciate Ligament: A Retrospective, Single-Center Study.

BACKGROUND Arthroscopic single-bundle surgical reconstruction of the anterior cruciate ligament (ACL) is often performed electively after 3 weeks of mobilization therapy. The present single-center retrospective study aimed to investigate the effects of temperature and volume of intraoperative normal saline irrigation on postoperative pain and swelling and on serum markers of inflammation following elective, arthroscopic, single-bundle surgical reconstruction of the ACL. MATERIAL AND METHODS Clinical data from 716 patients with non-acute ACL injuries who met the criteria between March 2015 and May 2020 were retrospectively analyzed. The patients were broken into 5 groups, depending on the volume or temperature of intraoperative irrigation with normal saline. At specific times after surgery, pain, knee swelling, and skin temperature were assessed. Postoperative levels of serum C-reactive protein (CRP), interleukin (IL)-1, IL-6, and IL-10 also were measured. RESULTS Visual analog scale (VAS) scores for pain, rates of swelling, and skin temperature differed significantly among the 5 groups at all postoperative time points (P<0.001). The VAS scores(P=0.322) and ratings for swelling (P=0.245), and skin temperature (P=0.093) were not significantly different among the volume groups. There were no significant differences in the VAS scores (P=0.055), swelling ratings (P=0.570), or skin temperatures (P=0.321) among the groups that received irrigation with normal saline at different temperatures. There were no significant differences in postoperative serum levels of CRP, IL-1, IL-6, or IL-10 among the groups (P>0.05). CONCLUSIONS Irrigation with different volumes and temperatures of normal saline did not have a significant effect on postoperative pain, swelling, or serum markers of inflammation.

Preeclampsia asociada a debut de lupus eritematoso sistémico y edema vulvar masivo gestacional / Severe preeclampsia associated with the onset of systemic lupus erythematosus and massive gestational vulvar edema / Pré-eclâmpsia grave associada a lúpus eritematoso sistêmico e edema vulvar gestacional maciço

El debut del lupus eritematoso sistémico (LES) durante el embarazo, intrincado con preeclampsia grave, asociado a edema vulvar masivo gestacional, es raro y de difícil diagnóstico. Se reporta una paciente de 19 años, con 35 semanas de gestación, que debutó con LES durante el tercer trimestre del embarazo, y que consulta por manifestaciones cutáneas, dadas por eritemas en pulpejos de dedos de manos. Se constata preeclampsia severa. Se realiza cesárea de urgencia, e ingresa a la unidad de cuidados intensivos. Instala edema de vulva masivo que incapacita la deambulación.

The onset of systemic lupus erythematosus during pregnancy, complicated with severe preeclampsia, associated with massive gestational vulvar edema, is rare and difficult to diagnose. A 19-year-old patient is reported, with 35 weeks of gestation, who started with systemic lupus erythematosus during her third trimester of pregnancy, and consulted due to cutaneous manifestations caused by erythema on the pads of the fingers. Severe preeclampsia was observed. An emergency cesarean section was performed, and the patient was admitted to the Intensive Care Unit. She developed a massive vulvar edema that disabled ambulation.

O aparecimento de lúpus eritematoso sistêmico durante a gravidez, intrincado com pré-eclâmpsia grave é raro e de difícil diagnóstico. É relatada uma paciente de 19 anos, com 35 semanas de gestação, que estreou com lúpus eritematoso sistêmico no terceiro trimestre de gestação, e que se consultou por manifestações cutâneas causadas por eritema nas pontas dos dedos das mãos. Também existe uma pré-eclâmpsia grave. E realizada cesárea de emergência e ela é internada na Unidade de Terapia Intensiva. Instala um edema vulvar maciço que impede a deambulação.