Fertility-Sparing Treatment in Gestational Choriocarcinoma: Evaluating Oncological and Obstetrical Outcomes in Young Patients.

BACKGROUND Gestational choriocarcinoma (GC) is an uncommon neoplasia that occurs in women who may not have completed a procreation plan. The aim of this study was to evaluate oncological and obstetrical outcomes in young patients with GC after fertility-sparing treatment. MATERIAL AND METHODS The eligibility criteria for the study were histopathological diagnosis of GC, age ≤40 years, and treatment with systemic chemotherapy. Patients who underwent upfront hysterectomy were excluded. The response to treatment was assessed according to beta-human chorionic gonadotropin (beta-hCG) serum measurement. Complete response and progression were considered if the beta-hCG dropped to a normal range and increased (or reached a plateau), respectively. The birth rate was calculated as the number of women who gave birth after treatment divided by the total number of patients. RESULTS A total of 18 patients fulfilled the study's eligibility criteria. A complete response and progression to first-line chemotherapy were found in 13 (72.22%) and 5 (27.78%) patients, respectively. Salvage treatment was administered to patients with progression. Overall, 16 (88.88%) patients achieved complete response after treatment and 2 (11.12%) died. GC relapse was diagnosed in 1 patient 62 months after treatment. The birth rate was 22.22%, and a total of 6 children were born. All pregnancies ended in term delivery. No congenital abnormalities were detected in the newborns. CONCLUSIONS GC is a life-threatening form of gestational trophoblastic neoplasia, mainly due to its rapid course and resistance to chemotherapy. Most patients with GC will not be able to bear children after treatment.

Guessing can benefit memory for related word pairs even when feedback is delayed.

Trying to guess what the correct answer to a question might be can facilitate future learning of this answer when presented in the form of corrective feedback. One issue that determines the effectiveness of guessing as a learning strategy is the timing of the presentation of feedback: it can be presented either immediately after the guess, or after a delay. Whereas the timing of feedback is of little importance for complex materials such as trivia questions, previous research suggests that for simpler materials such as related word pairs guessing seems to benefit learning only when feedback is immediate. In order to test whether this always has to be the case, we conducted two experiments in which we increased the richness of study materials by superimposing the to-be-learned word pairs over unrelated context pictures. We then manipulated the match between contexts at study and at test (Experiment 1) and at the time of feedback delivery (Experiment 2). Contrary to previous studies showing no benefits of guessing with delayed feedback, our results show that learning related word pairs can benefit from guessing even when feedback is delayed. These benefits of guessing occur if participants are reminded via reinstated contexts of the guessing stage at the time of feedback delivery. Our results help constrain theories of guessing benefits and extend theories of reminding.

Elaboration by superposition: From interference in working memory to encoding in long-term memory.

Distraction embedded in working memory tasks leads to impaired performance. This impairment is mitigated when targets and distractors that follow them share common features-a signature effect of interference by superposition. Here we propose that target-distractor similarity modulates not only forgetting from working memory but also encoding into long-term memory. In five experiments, we test this elaboration-by-superposition hypothesis, demonstrating that semantic relatedness between targets and distractors benefits delayed category-cued recall performance (Experiments 1a and 1b), which is not due to carry-over effects from working memory testing (Experiment 2). Just as in the case of working memory, this long-term memory effect is reduced when distractors precede targets (Experiment 3). Finally, we show that while high target-distractor similarity reduces forgetting from working memory, it produces net benefits for long-term memory performance (Experiment 4). Together, the results suggest that common mechanisms underlie encoding into working and long-term memory, and that bindings between features of spatiotemporal context and features of to-be-remembered items play a crucial role. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Women are not less field independent than men-the role of stereotype threat.

Prior research has shown that females are less field independent (FI) than males. However, when gender identity is salient, performance on tests assessing constructs similar to FI may be hindered, because of stereotype threat. This study examined the impact of stereotype threat on gender differences in FI. We expected that (a) reporting one's own gender prior to FI testing and (b) having an opposite-gender experimenter would activate stereotype threat, and in turn result in lower performance on a test of FI among females. Overall, 170 participants were randomly assigned to one of eight conditions in a between-participants design varying the participant's gender, experimenter's gender and timing of the gender question (before vs. after test). Results showed that reporting one's gender before the FI test led to lower FI performance among females. Furthermore, females achieved higher FI when experimenters were females and gender questions were administered after the FI test.

Comprehensive Treatment of the Multiply Injured Patient. A Case Study.

BACKGROUND: We describe the case of a 35-year-old man who suffered multiple organ injuries following a traffic accident. CASE REPORT: A total of 47 fractures were diagnosed in that patient. He was treated in stages according to the principles of Damage Control Orthopedics. He underwent 6 sessions of surgery with 23 surgical approaches. A follow-up examination at 12 months post injury found bone union of all fractures. The clinical and functional outcome of treatment was good as joint mobility was similar to the pre-accident status and the patient returned to work. CONCLUSIONS: In polytrauma patients, rapid and accurate diagnostic procedures combined with quick and accurate clinical decisions regarding treatment procedures have an impact on late outcomes. The order of stages of treatment should be determined by the general condition of the patient and type of injuries.

Surgical Treatment of Radial Head Fractures: Outcomes and Complications.

BACKGROUND: Appropriate treatment of radial head fractures remains an area of disputes and controversy. The present paper aims to assess the outcomes of surgical fixation of these injuries and identify the most common complications. MATERIAL AND METHODS: The medical records of 63 patients (25 women and 38 men) treated in 2011 -2014 were analysed retrospectively. The treatment outcomes were assessed according to the Broberg and Morrey rating system and the QuickDASH score. RESULTS: Of 21 patients with isolated fractures, all those with Type 2 fractures demonstrated excellent outcomes. In the group with Type 3 fractures, 11 patients showed satisfactory and 4 unsatisfactory outcomes. Of 19 patients with a fracture combined with elbow dislocation, all those with Type 2 fractures achieved excellent results while in the group with Type 3 fractures 8 patients had satisfactory and 4 had unsatisfactory outcomes. 23 patients were diagnosed with Hotchkiss' terrible triad; 7 of them had sustained Type 2 fractures and showed satisfactory outcomes while those with Type 3 fractures demonstrated 12 satisfactory and 4 unsatisfactory results. Complications included limited elbow mobility (59% of the patients), pain (52.9%), lower muscle strength (35.3%), posttraumatic arthrosis (29.4%), heterotopic ossification (11.8%) and nonunion (1.5%). Eleven patients required repeat surgery. CONCLUSIONS: 1. Today's materials used for the fixation of fracture fragments allow for a stable fixation of almost any fracture of the radial head. 2. As long as fixation of a given radial head fracture is technically possible, open reduction and internal fixation should be attempted. 3. If fixation is impossible, radial head replacement should be a method of choice.

Comparative Analysis of Clinical Outcomes of Tibial Plateau Fractures and Computed Tomography Examinations.

BACKGROUND: The aim of the study was to evaluate the outcomes of treatment of tibial plateau fractures. Based on CT examination, we set out to determine what factors were associated with a poor functional outcome. MATERIAL AND METHODS: The study involved 13 patients after surgery for tibial plateau fracture by locking plate osteosynthesis. CT studies using a MARS application were performed. The presence of subchondral defects was evaluated, including their area and depth. The reduction and widening of the tibial plateau were measured. The study data were correlated with the clinical outcome: pain according to a VAS scale, knee joint range of motion and the subjective IKDC score. RESULTS: Bone defects were observed in the majority of patients. On the basis of surface reconstruction, it was possible to accurately evaluate the articular step-off of the tibial plateau, which closely correlated with the range of motion and the subjective IKDC score (p <0.05). A correlation was also observed between widening of the lateral condyle and the IKDC score and pain level in the VAS scale (p<0.05). CONCLUSIONS: 1. Articular step-off and widening of the lateral condyle strongly correlates with the clinical outcome of tibial plateau fracture treatment. 2. The presence and extent of subchondral bone defects in the tibial plateau are related to knee pain in patients but have no effect on the range of motion and the IKDC score. 3. Bone graft remodeling cannot be fully assessed despite the use of MARS in CT imaging.

Comparison of different locking plate fixation methods in distal tibia fractures.

PURPOSE: The aim of our study was to assess the outcome of locking plate fixation of distal tibia fractures and evaluate which surgical approach and method of plate fixation is related to better functional result and lower complication rate. METHODS: A retrospective analysis of treatment of 45 patients was made. Patients were divided into two subgroups regarding surgical approach (medial vs anterior) and fixation method (bridge plating vs rigid fixation). Time from injury to full bone union was noted, and clinical outcome was assessed by AOFAS score. RESULTS: Nonunion was the most prevalent complication and was observed in 26.6 % of patients. Infection rate was 11.1 %. Higher rate of bone union complications was noted in the anterior approach group with anterolateral anatomical plate. Infection and re-operation rates were similar in all subgroups. There were no correlations between fracture extension, length of plate and screw placement with bone healing time and AOFAS score. CONCLUSIONS: Outcome of plate fixation of distal tibia fracture did not depend on the fixation method or surgical approach but, when possible, the medial plating via MIPO technique is a favourable method of treatment.

[Long-term outcomes after "anatomic" reconstruction of anterior cruciate ligament using central third of patellar tendon]. / Odlegle wyniki "anatomicznej" rekonstrukcji wiezadla krzyzowego przedniego przeszczepem 1/3 srodkowej wiezadla rzepki.

UNLABELLED: Reconstruction of the anterior cruciate ligament (ACL) is one of the most commonly performed procedures in orthopedics. AIM: The aim of the study was to evaluate long-term results of anterior cruciate ligament reconstruction using middle third patellar tendon grafts. MATERIALS AND METHODS: The study included 29 patients with an average 8 years follow - up. All patients underwent arthroscopic reconstruction of ACL using the central third of the patellar tendon ligament. The grafts attachment points were determined by using the Howell pointer. The average patient age was 36 years (range from 16 to 48 years). Postoperative assessment was based on the modified Lysholm score, intensity of the degenerative changes in the Lawrence-Kellgren scale and stabilometric measurments of the knee by Rolimeter and Telos Stress Device. RESULTS: According to the Lyscholm score 21 of 29 patients achieved good and very good result, 7 sufficient, and one case was reported as a bad result. Most of the unsatisfactory results were related with coexisting intraarticular injuries: meniscus and articular cartilage lesions. Outcomes of stabilometric measurments was strongly correlated with subjective results of survey. CONCLUSIONS: In spite evolution of techniques and the introduction of new methods of ACL reconstruction, treatments performed several years ago using the BPTB transtibial technique was possible to obtain good results of treatment.

Outcomes after Open Reduction and Plate Fixation of Distal Humerus Fractures.

BACKGROUND: Distal humerus fractures (DHFs) have been a serious challenge since the beginning of surgery. The outcome of surgical treatment of a DHF should not only be assessed with clinical ratings. It is also important to take into account the patient's subjective evaluation of limb function. MATERIAL AND METHODS: The study involved 26 patients after surgical treatment of DHF. The Quick DASH (QDASH) scale was used to assess the subjective results of surgical treatment of DHF, and the objective Mayo Elbow Performance Score (MEPS) was used to assess the clinical outcome. Relationships between the subjective and objective scores were tested with Pearson's correlation coefficient. RESULTS: 85% of the patients had excellent or good QDASH scores, and 65% of patients had excellent or good MEPS scores. The Pearson correlation coefficient between the subjective and objective assessments was -0.91, indicating total dependence. CONCLUSIONS: Open reduction and internal fixation using two perpendicular plates allows for achieving good stability of fixation, early rehabilitation and quick return to the desired level of activity, which contributes to a high percentage of good objective and subjective results of treatment. Subjective assessment of upper limb function after DHF surgery fully correlates with objective assessment.

[Thermal shrinkage of anterior cruciate ligament--if it works?]. / Termiczne skrócenie wiezadla krzyowego przedniego--czy to dziala?

UNLABELLED: Common used method of treatment of anterior cruciate ligament deficiency is reconstructive surgery. But in cases of incomplete tear of ligament or graft failure one of the treatment options is thermal shrinkage of remain tissue. Although this method is widespread among clinicians, still there are a lot of controversies. Some studies showed good short and midterms outcomes, but others authors described failure of this method in long term observations in form of secondary laxation of the ligament or its spontaneous rupture. The aim of this study was to investigate outcomes of thermal shrinkage of lax, partially torn anterior cruciate ligament or its graft. MATERIALS AND METHODS: In years 2006-2012 was conducted twenty five operations of thermal shrinkage of anterior cruciate ligament or its graft. Full data was obtained from twenty individuals. Anterior stability was assessed by stabilometric side to side tests with Telos Stress Device and Rolimeter. Patients was asked to complete a Lysholm questionnaire. Arthritic changes was assessed by X-Ray scans using Lawrence-Kellgren scale. To made a statistic analysis MS Excel was used. RESULTS: Among twenty individuals failure of treatment was found in eight cases (40%). Remaining twelve patients (60%) at control examination stated that they feel improvement after surgical treatment. Mean Lysholm score was 87 pts and its comparable to other authors investigations. We have to keep in mind that subjective outcome may be affected by associated injuries. CONCLUSIONS: Thermal shrinkage of anterior cruciate ligament may in some cases find a place as a therapeutic option. The effect of shortening the ligament and improvement of the subjective feeling of instability is noticeable in the short term follow-up, but due to reports in the literature, patients require further observation.

Outcomes for high-energy distal femur articular fractures.

BACKGROUND: Distal femur fractures are relatively rare injuries that usually require surgical treatment. Angular-stable plates allowing for anatomical repositioning and stable fixation of splinters, particularly in articular fractures, are commonly used in such cases. The goal of the study was to analyze the outcomes of the surgical treatment of high-energy articular fractures of distal femur. MATERIAL AND METHODS: The study included 22 patients treated in years 2007-2013. The average follow-up period was 39.5 months. The range of knee motion was recorded during follow-up visits. Treatment outcomes are presented using the Prichett's criteria as well as using IKDC and KOOS scores. Bone union and lower limb axial deformity were assessed using X-ray images. RESULTS: The average range of motion was 0-99 degrees. According to Prichett's criteria, a total of 54% good and very good results as well as 36% of satisfactory results were recorded. The average IKDC score was 59.4 points while the average KOOS score was 54.7 points Bone union was achieved in 91.6% of fractures. Axial deformity was rare, and correlation between the valgus angle and the clinical and functional outcomes was observed. CONCLUSIONS: The applied methods for internal fixation afforded satisfactory treatment outcomes in most patients with high-energy distal femur fractures. No significant reduction in the mobility of the affected knee or axial deformation are observed after proper repositioning of distal femur fracture splinters using an angular-stable plate.

Complex dislocation of the second metacarpophalangeal joint. Case report.

Dislocation of the second metacarpophalangeal joint is a rare injury and despite trivial symptoms generally requires operative treatment. We present a case of complex dislocation treated operatively from a volar approach. This approach allows good visualization and repair of the volar plate. K-wire stabilization for 3 weeks was enough to avoid joint instability and did not limit the range of motion.

Results of two-stage operative treatment of anteromedial instability of the knee.

BACKGROUND: Proper treatment of massive knee injuries still constitutes a challenge for clinicians. Most often a torsion knee injury results in a rupture of the medial collateral ligament and anterior cruciate ligament. There is still no consensus on whether total rupture (Grade III) of the medial collateral ligament requires surgery, but it is well known that anterior cruciate ligament injury will require reconstructive surgery. MATERIAL AND METHODS: A total of 27 patients treated with two-staged surgery (primary MCL repair and delayed ACL reconstruction) were enrolled. Treatment outcomes were evaluated using the IKDC scale and Lysholm scale. The range of motion and knee stability was assessed during a clinical examination. Radiographs were used to evaluate the placement of suture anchors and development of osteoarthritic lesions. Static and dynamic ultrasound examinations were also performed to assess the post-operative morphology and performance of the medial collateral ligament. RESULTS: The patients who had undergone surgery for combined anteromedial instability of the knee, achieved good or very good clinical outcome according to the IKDC scale (63%, 17 of 27) and the Lysholm scale (74%, 20 of 27). Unsatisfactory functional outcomes were more often seen in older patients. Some patients developed complications, which significantly worsened the outcome. Those mainly included a limited range of movement, arthrofibrosis and Pellegrini-Stieda lesions. CONCLUSIONS: 1.Two-stage operative treatment produces good or very good results in most patients. Nevertheless, there is a risk of complications in some cases, mostly in patients aged 40 years. Accordingly, two-stage treatment is currently recommended in younger individuals. 2. A complete MCL tear at the distal attachment should be given particular attention. Although such injury is rare, due to the anatomical determinants and the risk of Stener-like lesions, i.e. unhealed ML, surgery is recommended. Surgery produces good clinical and functional results.

Outcome of comminuted proximal humerus fracture treatment with locking compression plate.

BACKGROUND: Therapeutic management of proximal humerus fractures is still controversial. There are several ways of proceeding in these cases, ranging from conservative treatment to shoulder joint arthroplasty. Open surgical reduction and stabilization with a locking compression plate is currently the most widely used method of treatment, especially in younger patients. The purpose of this study is to analyze the results of surgical treatment of fractures of the proximal humerus using locking compression plates. MATERIAL AND METHODS: The study included 69 patients, 57 of them reported for the follow-up (82.6% of respondents). Clinical and radiological evaluation was performed at 6 weeks and 6 months following the surgery. Functional outcome was assessed using the Constant score. We also evaluated shoulder flexion active range of motion. Bone union and common complications were evaluated on the basis of radiographs--humeral head necrosis and the evidence of loosening of the bone-binding material. RESULTS: The mean Constant score was 68.9 points and 75.94% relative to the opposite limb (relative mean score). No bone healing was observed in 7% (4 of 57) patients. There was a total of 21% (12 of 57) cases of humeral head necrosis. These changes varied in nature, location and severity. In 2 cases, reoperation was required due to loosening of the bone-binding material. Shoulder flexion active range of motion averaged 132 degrees and was lower in cases of 4-part fractures. CONCLUSIONS: Surgical treatment of stable 3-part fractures of the proximal humerus using locking compression plate should be the treatment of choice in younger patients. Given the poor results, the choice of treatment involving 4-part fractures should be individually tailored.