Comparing endoscopic and open decompression of the ulnar nerve in cubital tunnel syndrome: a prospective randomized study.

BACKGROUND: Prospective randomized data is currently lacking which compares endoscopically assisted surgery with open surgical techniques in the treatment of cubital tunnel syndrome (CUTS). The aim of this study is to compare patient outcome in both techniques. METHOD: This prospective study comprised of 45 patients who, between October 2014 and February 2017, were randomly assigned to undergo either endoscopic or open surgery (22 and 23 patients respectively) for decompression of the ulnar nerve. Patients were followed up at 3 and 12 months postoperation. McGowan classification was used to determine the severity of symptoms. Surgical outcome was evaluated by Bishop classification. Pain levels were monitored according to gender from 0 to 10 days postoperation. Other factors investigated were chronic scar pain, working status, operation duration, and patient satisfaction regarding postoperative scarring and the procedure itself. RESULTS: Both methods are equally effective in the treatment of CUTS (Bishop score excellent or good 90% vs 96%). Postoperative pain is significant particularly in the first few days following surgery, but with no significant difference depending on procedure. In the open group, postoperative pain was significantly higher in women than in men; pain did not differ between the sexes in the endoscopic group. The tendency to lower levels of pain among endoscopically operated women in comparison with women in the open group was not statistically notable. Patients who underwent open decompression experienced notably higher levels of postoperative chronic scar pain. Although working status and satisfaction with the surgical outcome were the same in both groups, satisfaction with scarring was higher in the endoscopy group. Operation time was significantly longer by endoscopy. CONCLUSIONS: Both studied methods produced equal satisfactory outcomes in the treatment of CUTS. Endoscopy has the potential to minimize chronic scar pain and improve scarring esthetics, at the expense of longer operating time. CLINICAL TRIAL REGISTRATION NUMBER: Supported by Ministry of Health, Czech Republic-conceptual development of research organization (FNOs/2014, project number 20). Graphical abstract Median postoperative pain from 0 to 10 days by group.

Spontaneous improvement in both obstructive sleep apnea and cognitive impairment after stroke.

BACKGROUND: Knowledge available about the relationship between obstructive sleep apnea (OSA) and cognitive impairment after stroke is limited. The evolution of OSA and cognitive performance after stroke is not sufficiently described. METHODS: We prospectively enrolled and examined acute stroke patients without previously diagnosed OSA. The following information was collected: (1) demographics, (2) sleep cardio-respiratory polygraphy (PG) at 72 h, day seven, month three, and month 12 after stroke, (3) post-stroke functional disability tests at entry and at months three and 12, and (4) cognition (attention and orientation, memory, verbal fluency, language, and visual-spatial abilities) using the revised Addenbrooke's Cognitive Examination (ACE-R) at months three and 12. RESULTS: Of 68 patients completing the study, OSA was diagnosed in 42 (61.8%) patients. The mean apnea/hypopnea index (AHI) at study entry of 21.0 ± 13.7 spontaneously declined to 11.6 ± 11.2 at month 12 in the OSA group (p < 0.0005). The total ACE-R score was significantly reduced at months three (p = 0.005) and 12 (p = 0.004) in the OSA group. Poorer performance on the subtests of memory at months 3 (p = 0.039) and 12 (p = 0.040) and verbal fluency at months 3 (p < 0.005) and 12 (p < 0.005) were observed in the OSA group compared to non-OSA group. Visual-spatial abilities in both the OSA (p = 0.001) and non-OSA (p = 0.046) groups and the total ACE-R score in the OSA (p = 0.005) and non-OSA (p = 0.002) groups improved. CONCLUSIONS: A high prevalence of OSA and cognitive decline were present in patients after an acute stroke. Spontaneous improvements in both OSA and cognitive impairment were observed.

[One-day simultaneous bilateral cataract surgery]. / Jednodenní oboustranná operace katarakty. Vlastní výsledky.

INTRODUCTION: Effectiveness Evaluation of One-Day Simultaneous Bilateral Cataract Surgery (SBCS) Comparing to the Cataract Surgery Performed on Each Eye Separately After a Lapse of Time. MATERIAL AND METHODS: The cohort of 100 patients (200 eyes) consisted of two groups: In the Group1, there were 50 patients (100 eyes) who underwent One-day Simultaneous Bilateral Cataract Surgery (SBCS). The Group 2 consisted 50 patients (100 eyes) who had the surgery on one eye first, and later on the fellow eye. The course of the surgery, peroperative and postoperative complications were evaluated. The patients from the Group 1 were examined at the first postoperative day. In the next course, all patients were examined one week, one month, and 3 months after the surgery. In the postoperative phase were, besides the complications, the final visual acuity and refraction and its deviations from the target refraction followed up. RESULTS: Course of the surgery, peroperative and postoperative complications are comparable in both groups. Endophthalmitis, or other more serious postoperative complications did not appear in either group. Three months after the surgery, the uncorrected visual acuity (UCVA) 0.8 and better in the Group 1 had 75 % of patients, and in the Group 2 also 75 % of patients. The UCVA 0.5 and better in the Group 1 had 95 % of patients; in the Group 2 it had 90 % of patients. The best-corrected visual acuity 0.8 and better had in both groups 95 % of patients. The final refraction after 3 months in the Group 1 was -0.15 ± 0.91 (-0.12); -3.37; 2.00. In the Group 2 the final refraction after 3 months was -0.08 ± 0.91 (0.00); -3.25; 2.75. CONCLUSION: The results are showing that both groups of our cohort are comparable. The One-Day Simultaneous Bilateral Cataract Surgery (SBCS) is, from the surgical point of view, equally safe and effective as classically performed cataract surgery.Key words: One-Day Simultaneous Bilateral Cataract Surgery (SBCS), refraction, visual acuity, postoperative complications, intraocular pressure.

[Vacuum-assisted vaginal delivery does not significantly contribute to the higher incidence of levator ani avulsion]. / Vaginální porod s pouzitím vakuumextraktoru není spojen se signifikantne vyssím výskytem avulzního poranení levátoru

OBJECTIVE: To draw a comparison between spontaneous vaginal delivery and vacuum-assisted vaginal delivery in relation to the incidence and the type of levator ani avulsion in primiparas. DESIGN: Retrospective observational study. SETTIMG: Department of Obstetrics and Gynaecology, University Hospital of Ostrava. METHODOLOGY: In the study, the primiparas who were from 6 to 12 months after spontaneous vaginal delivery (group A, n = 52) or after childbirth with vacuum extraction (group B, n = 51) underwent translabial 3D ultrasound. The obstetric data had been obtained from the hospital database. Translabial 3D ultrasound examination were performed by two sonographists. The monitored parameter was the distance between urethra and fibres of musculus levator ani - levator urethra gap [6]. The distance longer than 25 mm was considered an avulsion injury [6, 22]. Other parameters assessed in relation to the avulsion were: women's age, BMI, epidural analgesia, episiotomy performance, the length of the first and the second stages of labour, and fetal weight. RESULTS: Musculus levator ani avulsion was diagnosed in 10 women - unilateral in 8 cases and bilateral in 2 cases. In group A, women after spontaneous birth, we noticed avulsion injury in 7.7% of cases, whereas in group B, women after vacuum extraction, we recorded avulsion injury in 11.8% of cases. Thus the use of vacuum extraction is not statistically significant risk factor for avulsion musculus levator ani. Statistically significant difference in comparison group A and B was recorded in BMI, the length of the second stages of labour and episiotomy performance. CONCLUSION: We did not prove a statistically significant connection between avulsion injury and delivery with the use of vacuum extraction in comparison to avulsion injury incidence in uncomplicated vaginal delivery group (tab. 1). Vacuum extraction does not appear as a risk factor for avulsion in contrast to forceps delivery.

Early identification of women with HELLP syndrome who need plasma exchange after delivery.

OBJECTIVES: To compare the laboratory course of HELLP syndrome between patients who recover and those who progress to postpartum thrombotic microangiopathic syndrome (PTMS) and require postpartum plasma exchange (PPEX) and to describe maternal characteristics and morbidity in women with PTMS. METHODS: In this retrospective analysis, 81 patients recovered and 5 progressed. Values for aspartate aminotransferase (AST), lactate dehydrogenase (LDH), bilirubin, platelets (Plt), urea, and creatinine at 0, 8, 16, 24, 48, and 72 hours postpartum in both groups were analyzed and compared. We also described maternal characteristics and morbidity of patients who progressed to PTMS. RESULTS: Patient groups differed significantly at 72 hours postpartum for Plt and LDH values and at 24 and 48 hours for bilirubin. Trends for AST and Plt differed significantly between the recovery and progression groups in the first 48 hours. Patients who progressed had acute kidney injury and other severe maternal morbidity, including one case of maternal death. CONCLUSIONS: Women with HELLP syndrome without clear Plt and AST improvement in the first 48 hours and with acute kidney injury, neurological impairment, or respiratory distress syndrome are at risk of progressing to PTMS. They should be administered PPEX between 24 and 72 hours postpartum.

[Treatment Results of the Diabetic Macular Edema by Means of the PASCAL Laser System]. / Výsledky lécby diabetického makulárního edému laserovým systémem PASCAL.

OBJECTIVE: To evaluate functional, anatomical and clinical efficacy, and safety of the pattern scanning laser (PASCAL®) photocoagulation in patients with diabetic macular edema and absence of proliferative diabetic retinopathy. METHODS: From 2008 to 2013 84 eyes of 58 patients (30 men, 28 women) were treated with pattern laser photocoagulation at the Ophthalmology Department at University Hospital Ostrava. Average age at the baseline visit was 65 years. The inclusion criteria included nonproliferative diabetic retinopathy (84 eyes), focal DME (14 eyes), diffuse exudative DME (70 eyes). All the eyes were "treatment naive". The average duration of diabetes was 18 years, average baseline HbA1c value was 8,4%. Either focal laser photocoagulation or grid photocoagulation was performed with the PASCAL photocoagulator. Best corrected visual acuity (BCVA), central retinal thickness (CRT), fundus photography, biomicroscopy and complications were evaluated during the minimum 12months follow-up period. Statistical analysis using parametrical and nonparametrical tests with p less than 0,05 was done. RESULTS: Mean baseline BCVA was 0,43 logMAR. Values 0,38, 0,37, 0,38 a 0,38 logMAR were observed in the follow-up intervals in the 4th, 6th, 12th and 18th month. In 4 eyes (5%) improvement of more than 3 lines was observed, in 26 eyes (31%) improvement from 0 to 3 lines was observed, in 52 eyes (62%) decrease from 0 to 3 lines was observed and in 2 eyes (2%) decrease of more than 3 lines was observed. Mean baseline CRT was 398 µm, values 370 µm, 362 µm, 349 µm and 338 µm were observed in the follow-up intervals in the 4th, 6th, 12th and 18th month. At the 12th month visit 76 eyes (90%) were stabilized, and in 8 eyes (10%) progression of the disease was observed. No complications were observed during the first 12 monhts follow up. CONCLUSION: Pattern scanning laser photocoagulation of DME lead to BCVA and clinical stabilization. In addition to this, it lead to decrease of the CRT. The efficacy was comparable to traditional laser systems with no apparent benefit to the traditional systems. The efficacy was inferior to modern intraocular anti-VEGF (vascular endothelial growth factor) drugs.

Semi-spherical Radiofrequency Bipolar Device - A New Technique for Liver Resection: Experimental In Vivo Study on the Porcine Model.

The incidence of colorectal carcinoma is still growing in the Czech Republic and also all around the world. With success of oncological treatment is also growing a number of potential patients with liver metastases, who can profit from surgical therapy. The aim of this study was to confirm on porcine models that this method by using new surgical device is effective and safe for patients who have to undergo liver resection. The primary hypothesis of the study was to evaluate whether this new device is able to consistently produce homogeneous and predictable areas of coagulation necrosis without the Pringle maneuver of vascular inflow occlusion. The secondary hypothesis of the study was to compare the standard linear radiofrequency device and a new semi-spherical bipolar device for liver ablation and resection in a hepatic porcine model. Twelve pigs were randomly divided into two groups. Each pig underwent liver resection from both liver lobes in the marginal, thinner part of liver parenchyma. The pigs in first group were operated with standard using device and in the second group we used new developed semi-spherical device. We followed blood count in 0(th), 14(th) and 30(th) day from operation. 14(th) day from resection pigs underwent diagnostic laparoscopy to evaluate of their state, and 30(th) day after operation were all pigs euthanized and subjected to histopathological examination. Histopathological evaluation of thermal changes at the resection margin showed strong thermal alteration in both groups. Statistical analysis of collected dates did not prove any significant (p < 0.05) differences between standard using device and our new surgical tool. We proved safety of new designed semi-spherical surgical. This device can offer the possibility of shortening the ablation time and operating time, which is benefit for patients undergoing the liver resection.

[Metal staples versus conventional suture for wound closure in total knee arthroplasty]. / Pouzití kovových klipu pri suture kuze u totální endoprotézy kolene.

PURPOSE OF THE STUDY: Surgical incision closure, as well as total joint replacement itself, plays a key role in the overall outcome of an arthroplasty procedure. Uncomplicated wound healing is the essential condition of successful rehabilitation and the patient's return to normal activities. Although there are many innovative suturing techniques which offer advantages, their safety is still being discussed. The aim of this prospective non-blind randomised study was to evaluate wound healing and complications in relation to skin incision closure with either conventional suture or metal staples. MATERIAL AND METHODS: A total of 72 patients, 21 men and 51 women, who underwent a standard primary total knee arthroplasty (TKA) at our department in the period from January till June 2013, were evaluated. They were allocated to two groups by random assignment based on the patient's date of birth (even or odd day of birth). In group 1 (n=39) skin was closed using metal staples (Leukosan Skin Stapler), in group 2 (n=33), conventional continuous Donati suture was used. The groups, previously assessed as independent and comparable in terms of age, gender and BMI, were compared in the following criteria: suturing time, duration of wound drainage, wound healing, complications, resuturing when necessary, and their relation to the body mass index, skin plica thickness and co-morbidities potentially complicating soft tissue healing. The differences were statistically evaluated by parametric and non-parametric tests, i.e., the median test, χ(2)-test, Student's t-test, Fisher's exact test and Pearson's correlation coefficient. The statistical significance of differences was set at a level of 0.05. RESULTS: A significant difference (p<0.005) between the groups was found in suturing time; the median time for staples was 81 sec in comparison with 290 sec for conventional suture. In both groups, staples or sutures were removed on the 12 th postoperative day and there was no difference in wound drainage (median time, 5 days; p=0.891 for both). Treatment for late discharge was required in two sutured wounds (6.1%) and in three stapled wounds (7.7%). One of the latter was due to early deep wound infection, which later resulted in revision TKA. The groups did not differ in the values of either BMI or plica thickness (Pearson's r). DISCUSSION: Views on alternative suture techniques for skin closure in orthopaedic surgery vary. In this study, the use of metal staples or conventional suture is compared between two groups of patients undergoing TKA, i.e., the same type of procedure. The advantage of staples involves a quick and simple application but, as reported, removal may be more painful with staples than with stitches, and much depends on the technique of staple application. The continuous suture technique may produce skin strangulation at wound margins, which will complicate healing. Staples minimise this risk and are therefore commonly used in TKA surgery. However, only very few studies comparing these two suture techniques in TKA patients have been published. CONCLUSIONS: Correctly performed skin suturing by means of metal staples is not associated with a higher complication rate and is therefore a simple, rapid, efficient and economical alternative to the conventional suture technique.

Cell therapy, a new standard in management of chronic critical limb ischemia and foot ulcer.

Fifty percent of diabetics (7% of general population) suffer from peripheral arterial occlusive disease, which may lead to amputation due to critical limb ischemia (CLI). The aim of our study was to prevent major limb amputation (MLA) in this group of patients using a local application of autologous bone marrow stem cells (ABMSC) concentrate. A total of 96 patients with CLI and foot ulcer (FU) were randomized into groups I and II. Patients in group I (n = 42, 36 males, 6 females, 66.2 ± 10.6 years) underwent local treatment with ABMSC while those in group II (n = 54, control, 42 males, 12 females, 64.1 ± 8.6 years) received standard medical care. The frequency of major limb amputation in groups I and II was 21% and 44% within the 120 days of follow up, respectively (p < 0.05). Only in salvaged limbs of group I both toe pressure and toe brachial index increased (from 22.66 ± 5.32 to 25.63 ± 4.75 mmHg and from 0.14 ± 0.03 to 0.17 ± 0.03, respectively, mean ± SEM). The CD34(+) cell counts in bone marrow concentrate (BMC) decreased (correlation, p = 0.024) with age, even though there was no correlation between age and healing. An unexpected finding was made of relative, bone marrow lymphopenia in the initial bone marrow concentrates in patients who failed ABMSC therapy (21% of MLA). This difference was statistically significant (p < 0.040). We conclude ABMSC therapy results in 79% limb salvage in patients suffering from CLI and FU. In the remaining 21% lymphopenia and thrombocytopenia were identified as potential causative factors, suggesting that at least a partial correction with platelet supplementation may be beneficial.