Laparoscopic Cholecystectomy with Intraoperative Cholangiogram and Antegrade Biliary Stenting in Acute Gallstone Pancreatitis: A Pilot Study.

Aims: To demonstrate feasibility and efficacy of simultaneous intraoperative cholangiogram (IOC) and antegrade biliary stenting (ABS) with laparoscopic cholecystectomy (LC) compared with preoperative biliary investigation and delayed LC in acute gallstone pancreatitis (AGP). Methods: A retrospective case-control study was performed comparing patients who had a simultaneous IOC ± ABS with LC at index admission with those who had delayed LC in the treatment of AGP. 74 patients were included in this study from January 2016 to October 2018. All patients who underwent LC for AGP were included in a prospective database with 1 year follow-up. Results: 30 (40.5%) patients underwent simultaneous IOC ± ABS with LC, 11 of these required ABS insertion. 2 (6.7%) patients also underwent magnetic resonance cholangiopancreatography (MRCP). No patients underwent endoscopic retrograde cholangiopancreatography (ERCP). No patients were readmitted with AGP or symptomatic gallbladder. Mean length of total hospital admission was 10.1 days. 44 (59.5%) patients underwent delayed LC. Of this cohort, 7 (15.9%) patients underwent ERCP and 19 (43.2%) underwent MRCP. In total, there were 19 (43.2%) readmissions in this group with pancreatitis or symptomatic gallbladder. Mean length of total hospital admission was 13 days. Conclusions: In our pilot study we demonstrated that performing simultaneous IOC ± ABS with LC is a feasible option in the secondary care setting. Using this surgical technique, we have demonstrated a reduction in readmissions with AGP and symptomatic gallbladder while also reducing the number of CBD investigations required. Using simultaneous IOC ± ABS with LC reduced the mean total length of stay in hospital.

Reduction of an in vitro Intraradicular Multispecies Biofilm Using Two Rotary Instrumentation Sequences.

OBJECTIVE: The purpose of this research was to investigate the effect per se of two shaping and cleaning techniques on the reduction of an in vitro multispecies biofilm. MATERIALS AND METHODS: A total of 39 freshly extracted monoradicular teeth for periodontal reason were decoronated. Roots were sectioned longitudinally. After autoclaving, a specific stressed biofilm was grown on the root halves that were subsequently reassembled in a silicone index. Two treatments (n = 9 each)-RaCe (Schottlander; Letchworth Garden City, United Kingdom) and ProTaper Gold ( PTG; Dentsply Maillefer, Baillagues, Switzerland)-were tested; three noninstrumented samples served as a control group and three were rinsed with saline. Posttreatment samples were taken at three different levels of the root. Colony-forming units were counted after incubations. Additionally, three treatments (n = 5 each)-RaCe, PTG, and saline only-were evaluated under a confocal laser scanning microscope (CLSM). STATISTICAL ANALYSIS: Statistical analysis was conducted using Tukey's test and analysis of variance to evaluate the post-instrumentation bioburden. RESULTS: Both instrumentations were able to reduce the biofilm; however, differences were not present between them (p > 0.05). CLSM showed biofilm killing and disruption through mechanical shaping alone. CONCLUSIONS: Intraradicular biofilm is reduced with mechanical shaping. There was no difference between RaCe and PTG systems in biofilm reduction despite differences in design, file sequence, and rotational speed.

Primary meningococcal septic arthritis with multiple native joint involvement.

A previously healthy 18-year-old woman presented with an acutely painful, swollen right ankle joint, with similar symptoms subsequently developing in the right hip and right wrist. Microbiological samples from the ankle aspirate grew Neisseria meningitidis She had had no preceding clinical symptoms of meningitis or previous contact with a patient with meningitis. She was treated with intravenous antibiotics and surgical drainage.On follow-up, her symptoms had resolved, inflammatory markers had returned to normal and she has no long-term sequelae of septic arthritis. Primary meningococcal septic arthritis in the adult population is extremely uncommon, and makes up approximately 1% of all cases of primary septic arthritis.

The use of a 3-dimensional computed tomography bone database to evaluate the risk of distal contact between the rasp tip and the endosteal cortical bone.

PURPOSE: To use a 3-dimensional computed tomography (CT) bone database to evaluate the risk of distal contact between the rasp tip and the endosteal cortical bone. METHODS: Using a 3-dimensional CT bone database, the rasps for Exeter stems of 125 mm in length and body size 1, with a femoral offset of 37.5, 44, or 50 mm were compared with those for Exeter stems of 150 mm in length and same body size with the corresponding femoral offset. Rasp geometry was determined using an engineering drawing software. RESULTS: Of the 631 femurs in the database, 238 (187 Caucasian and 51 Asian) were of appropriate femoral offset and proximal body size to receive a stem with an offset of 37.5, 44, or 50 mm. Of these, 145 (115 Caucasian and 30 Asian) femurs were of champagne-flute type; the prevalence was comparable between the 2 populations (61% vs. 59%, p=0.729). When using the 150-mm rasp, 70 (55 Caucasian and 15 Asian) of the 238 femurs had distal contact between the rasp and femoral cortex; the prevalence was comparable between the 2 populations (29% vs. 29%, relative risk=1.0, p=1.0). Distal contact between the rasp and femoral cortex occurred more commonly in champagne-flute-type femurs than other femurs in the anteroposterior plane (28% [41/145] vs. 2% [2/93], relative risk=13.1, p<0.001) and in the mediolateral plane (27% [39/145] vs. 14% [13/93], relative risk=1.92, p=0.019). When using the 125-mm rasp, only one femur (with a canal flare index of 4.52) had distal contact in the mediolateral plane with an offset of 37.5 mm. Distal contact between the rasp and femoral cortex occurred more often with the 150-mm rasp than the 125-mm rasp in both planes (p<0.001). CONCLUSION: The use of a shorter stem may enhance anatomic fit in patients with a narrow femoral canal and prevent distal contact between the rasp and femoral cortex.

Triple arthrodesis of the foot with allograft through a lateral incision in planovalgus deformity.

BACKGROUND: Triple arthrodesis may be performed using various surgical approaches, most typically through two incisions and without structural bone graft. We have found that a single lateral incision allows adequate surgical exposure and structural bone graft facilitates lateral column reconstruction. METHODS: A consecutive series of 30 triple arthrodeses with additive bone graft using a single lateral incision. Outcome measures were SF12 score, Manchester-Oxford Foot Questionnaire index score, visual analogue pain score and satisfaction scores, and radiographic assessment at 3, 6 and 12 months post-operatively. RESULTS: Statistically significant improvements were seen in all measured outcomes, except the SF12 mental component score. The union rate was 100% with no loss of correction at 12 months. Twenty-nine out of 30 patients were satisfied. CONCLUSIONS: In this series, triple arthrodesis using structural allograft through a single lateral incision was safe and effective, with restoration and maintenance of surgical deformity correction and foot length.

Factors associated with one-year outcome after distal radial fracture treatment.

PURPOSE: To identify factors that affect functional outcome one year after distal radial fracture treatment. METHODS: 521 women and 121 men aged 16 to 92 (mean, 59) years with distal radial fractures underwent external fixation (n=123), open reduction and internal fixation (n=63), a combination of both (n=10), distal radial osteotomy for symptomatic malunion (n=90), or casting with (n=194) or without (n=162) prior closed manipulation under regional anaesthesia. The indication for surgery (rather than casting) was metaphyseal instability. Radiographic evaluation (dorsal angulation, radial shortening, carpal malalignment, and malunion) was made before and after treatment and after fracture healing. Functional evaluation (range of movement, grip strength, and activities of daily living) was made at a mean of 16 (range, 6-54) months after injury. RESULTS: After multiple regression analysis, poorer functional score was associated with increasing age (p<0.001), dorsal angulation after healing (p<0.016), presence of volar comminution (p=0.005), and pain (p<0.001). Poorer grip strength was associated with non-dominant side injury, increasing age, dorsal angulation after healing, positive ulnar variance, comminution, and pain (all p<0.001). Predicted malunion showed colinearity with age (r=0.657), dorsal comminution (r=0.694), and dorsal angulation (r=0.626). CONCLUSION: Understanding factors associated with outcome helps surgeons to make the treatment decision for distal radial fracture to achieve optimum outcome.

Transforaminal endoscopic spinal surgery: the future 'gold standard' for discectomy? - A review.

BACKGROUND: Lumbar disc prolapse is common and the primary method of care in most centres is still open discectomy facilitated by microscope or loupe magnification and illumination. Hospitalisation may be less than 24 h, but post-operative pain usually requires an overnight stay. This review describes transforaminal endoscopic spinal surgery (TESS) using HD-video technology, that is generally performed as a day case procedure under sedation or light general anaesthesia, and collates the evidence comparing the technique to microdiscectomy. METHODS: The method of TESS is described and an electronic literature search performed to identify papers reporting clinical outcomes. International data were translated where necessary and proceedings' abstracts included. In addition, papers held by the authors and colleagues in personal libraries were carefully cross-referenced to the obtained database. RESULTS: Analysis of the data supports the use of a transforaminal endoscopic approach to the lumbar intervertebral disc and suggests that outcomes following surgery are at least equivalent to those following microdiscectomy. Significant cost-savings in terms of in-patient stay may be generated. In addition, there is also some evidence supporting endoscopic surgery for relief of foraminal stenosis. CONCLUSION: Based on current evidence there are good arguments supporting a more wide-spread adoption of transforaminal endoscopic surgery for the treatment of lumbar disc prolapse with or without foraminal stenosis.

The complication rate and medium-term functional outcome after total hip replacement in smokers.

We aimed to study the effect of smoking on the complication rate and medium-term functional outcome after total hip replacement. 1767 patients undergoing a cemented THR in one hospital were followed up prospectively at 6, 18, 36, and 60 months. Harris Hip Scores, SF-36 scores and complications were recorded. There was no statistically significant difference in early complications and length of hospital stay between smokers and those patients who had never smoked. Smokers were less likely to require a blood transfusion and showed a statistically lower Harris Hip Score at six months but there was no difference seen at the subsequent time-points to five years after surgery. Smoking did not influence the complication rate or medium-term functional outcome at five years after total hip replacement.

Lactobacillus plantarum 299: beneficial in vitro immunomodulation in cells extracted from inflamed human colon.

BACKGROUND AND AIM: The present study determined the pattern of cytokine secretion (interleukin [IL]-1beta, tumor necrosis factor [TNF]-alpha, interferon [IFN]-gamma and IL-10) and their cellular sources in mononuclear cells isolated from colonic mucosa from normal and ulcerative colitis (UC) in response to probiotic and pathogenic bacteria. METHODS: Mononuclear cells were extracted from normal and active UC colonic mucosa and incubated with pure sonicates of probiotic, commensal, and pathogenic bacteria. Cytokine secretion was measured in culture supernatant and intracellular cytokine staining measured using fluorescent-activated cytometry. RESULTS: In mononuclear cells isolated from normal mucosa, significant increases in mean IL-1beta were observed with enteropathogenic Escherichia coli (286.3 +/- 138.7 pg/mL P < 0.05) and E. coli (440.5 +/- 194.0 pg/mL P < 0.01) compared with unstimulated control cells (16.7 +/- 4.8 pg/mL). In contrast, mononuclear cells isolated from active UC mucosa produced significant increases in mean IL-1beta in response to stimulation with Salmonella dublin (230.5 +/- 38.8 pg/mL P < 0.05), enteropathogenic E. coli (231.7 +/- 45.3 pg/mL P < 0.05) and E. coli (465.4 +/- 60.2 pg/mL P < 0.001) compared with unstimulated control cells (60.7 +/- 17.1 pg/mL). Escherichia coli also produced significant mean increases of TNF-alpha and IFN-gamma compared with unstimulated control cells. No significant increases in IL-1beta, TNF-alpha or IFN-gamma were observed with Lactobacillus plantarum in cells derived from normal or inflamed mucosa. Strikingly, incubation of L. plantarum with mononuclear cells isolated from active UC mucosa resulted in significant increases of mean IL-10 (327 +/- 53.5 pg/mL, P < 0.05) compared with unstimulated control cells (29.7 +/- 13.2 pg/mL). Intracellular cytokine staining confirmed T-cell and macrophage IL-10 production after L. plantarum stimulation. CONCLUSIONS: Lactobacillus plantarum demonstrates beneficial immunomodulatory activity by increasing IL-10 synthesis and secretion in macrophages and T-cells derived from the inflamed colon. This may provide a mechanism through which probiotic bacteria ameliorate inappropriate inflammation and induce tolerance.