bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Experience in Prevention of Postoperative CSF Leaks Using Abdominal Fat Grafts in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas
Authors: Ahn Stephen , Park Jae-Sung , Kim Do H. , Kim Sung W. , Jeun Sin-Soo 
Published: August 2020

Abstract
Objective Cerebrospinal fluid (CSF) leaks are the most common complication during endonasal endoscopic transsphenoidal approach (EETSA) and prevention of postoperative CSF leaks is critical. In this study, we report a single surgeon's experience of sellar floor reconstruction using abdominal fat grafts for prevention of postoperative CSF leaks in EETSA for pituitary adenomas.
Study Design This study is presented as case series with retrospective chart review.
Setting Present study was conducted at tertiary referral center.
Participants A total of 216 patients who underwent surgery via EETSA for pituitary adenomas between 2008 and 2018 at our institution were evaluated. When an intraoperative CSF leak occurred, sellar floor reconstruction was performed using a fat graft harvested from the abdomen via a 2-cm skin incision.
Main Outcome Measures Primary outcome and measures of this study was postoperative CSF leaks.
Results A total of 53 patients showed intraoperative CSF leaks (24.5%) and 2 patients showed postoperative CSF leaks (0.93%). There were no postoperative CSF leaks in any patients who showed intraoperative CSF leaks and received sellar floor reconstruction using fat grafts. There were also no postoperative CSF leaks in 12 patients who received preventative sellar floor reconstruction using fat grafts due to extensive arachnoid herniation without intraoperative CSF leaks. However, there were two postoperative CSF leaks in patients who did not show intraoperative CSF leaks and did not receive sellar floor reconstruction.
Conclusion The effectiveness of sellar floor reconstruction using abdominal fat grafts in patients receiving EETSA for pituitary adenoma was reported. We suggest that identification of intraoperative CSF leaks is important and preventive sellar floor reconstruction without evidence of intraoperative CSF leaks can also be beneficial.
Severe Spinal Infection after Vertebral Fracture Stabilization: A Narrow Escape
Authors: Maurya Ved Prakash , Elangovan D. , Mourougayan V. , Ranjini M. 
Published: August 2020

AbstractSpinal cord injury is typical following fall from height. The thoracolumbar vertebra undergoes maximum fracture following trauma. A 26-year-old man was brought to the emergency department with a history of fall from height. Clinical examination showed weakness in lower limbs with the inability to pass urine. Magnetic resonance imaging (MRI) of spine done elsewhere was suggestive of loss of second lumbar (L2) vertebral body height with compression over the lower end of the cord. Computed tomography (CT) scan of the spine revealed a burst fracture of L2 vertebra with bone fragments protruding into the spinal canal. The patient was taken up for spinal decompression with stabilization. His hospital stay was uneventful, and two weeks after discharge he was readmitted with wound bulge over the operative site. We started him on intravenous antibiotics and did regular debridement of the wound. Later on, he underwent wound closure with flap rotation.At last follow-up, he was ambulant with bladder and bowel control. During treatment, the titanium implants were left in situ. The decision for implant removal in early wound infection is at the discretion of the operating surgeon, along with the timing and nature of the disease.
Double Beveling on Imaging: A Characteristic Feature of Entry and Exit Penetrating Injury Wound
Authors: Agrawal Amit , Kumar VA Kiran , Kiran NA Sai , Penchalaiah Bathalapalli , Vinay Harsha 
Published: August 2020

AbstractBeveling of the calvarial bone is reported in firearm exit wounds and stabbing injuries in forensic literature. Beveling in entry wounds is rare. We report a case of a 27-year-old man who sustained a nonfatal penetrating craniofacial injury due to motorbike brake handle, and completely recovered after conservative management. We describe the characteristic inward as well outward beveling on imaging due the penetrating trajectory of the motorbike break handle.
Role of Intraoperative ICP And CPP Measurement for Predicting Surgical Outcome in Severe Traumatic Brain Injury
Authors: VV Ramesh Chandra , Bodapati Chandra Mowliswara Prasad , Paradesi Rajesh 
Published: August 2020

Abstract
Introduction Traumatic brain injury (TBI) is one of the leading causes of mortality and disability worldwide, and optimizing the management of these patients is a continuing challenge. Intraoperative intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were evaluated for use as prognostic indicators after surgery for severe TBI. Although ICP and CPP monitoring is standard postsurgery treatment for TBI, very few studies have reported the use of ICP and CPP values monitored during surgery.
Objectives The objectives of this study were to evaluate the use of intraoperative ICP and CPP values as prognostic indicators and as subjective guidelines for managing severe TBI.
Materials and Methods All patients with severe TBI who underwent surgical decompression and ICP monitoring intraoperatively were included in our study from 2017 to 2018. We measured ICP and CPP values after creation of the first burr hole, after hematoma evacuation, and after wound closure.
Results From the analysis of receiver-operated characteristic (ROC) curves, we observed that ICP initial (cutoff > 28 mm Hg) and CPP initial (cutoff < 44.5 mm Hg) are the best predictors of unfavorable outcomes. Favorable outcome (Glasgow outcome scale [GOS] 4 and 5) and unfavorable outcome (GOS 1–3) after 6 months were achieved in 64.1 and 35.8% of patients, respectively. There was significant difference between the ICP and CPP values which are measured after the first burrhole, after hematoma evacuation, and after scalp closure in both favorable and unfavorable outcomes. The highest positive Pearson’s correlation coefficient is found between GOS and ICP and CPP after first burr hole.
Conclusion Monitoring ICP and CPP during surgery improves management in patients with severe TBI and provides an early prognostic indicator in such patients.
Immunomodulatory Effect of Hypertonic Saline Solution in Traumatic Brain-Injured Patients and Intracranial Hypertension
Authors: Quiñones-Ossa Gabriel A. , Shrivastava Adesh , Perdomo William Andres Florez , Moscote-Salazar Luis R. , Agrawal Amit 
Published: August 2020

AbstractTraumatic brain injury (TBI) is often associated with an increase in the intracranial pressure (ICP). This increase in ICP can cross the physiological range and lead to a reduction in cerebral perfusion pressure (CPP) and the resultant cerebral blood flow (CBF). It is this reduction in the CBF that leads to the secondary damage to the neural parenchyma along with the physical axonal and neuronal damage caused by the mass effect. In certain cases, a surgical intervention may be required to either remove the mass lesion (hematoma of contusion evacuation) or provide more space to the insulted brain to expand (decompressive craniectomy). Whether or not a surgical intervention is performed, all these patients require some form of pharmaceutical antiedema agents to bring down the raised ICP. These agents have been broadly classified as colloids (e.g., mannitol, glycerol, urea) and crystalloids (e.g., hypertonic saline), and have been used since decades. Even though mannitol has been the workhorse for ICP reduction owing to its unique properties, crystalloids have been found to be the preferred agents, especially when long-term use is warranted. The safest and most widely used agent is hypertonic saline in various concentrations. Whatever be the concentration, hypertonic saline has created special interest among physicians owing to its additional property of immunomodulation and neuroprotection. In this review, we summarize and understand the various mechanism by which hypertonic saline exerts its immunomodulatory effects that helps in neuroprotection after TBI.
The Effect of Iodium 30c on Experimental Visceral Leishmaniasis
Authors: Joshi Jyoti , Bandral Chetna , Manchanda Raj Kumar , Khurana Anil , Nayak Debadatta , Kaur Sukhbir 
Published: August 2020

AbstractBackground Leishmaniasis is one of several neglected tropical diseases that warrant serious attention. A disease of socio-economically poor people, it demands safer and cheaper drugs that help to overcome the limitations faced by the existing anti-leishmanials. Complementary or traditional medicines might be a good option, with an added advantage that resistance may not develop against these drugs. Thus, the present investigation was performed to evaluate the anti-leishmanial efficacy of an ultra-diluted homeopathic medicine (Iodium 30c) in experimental visceral leishmaniasis (VL).Methods Compliant with strict ethical standards in animal experimentation, the study was performed in-vivo in inbred BALB/c mice which were injected intravenously with 1 × 107 promastigotes of Leishmania donovani before (therapeutic) or after (prophylactic) treatment with Iodium 30c for 30 days. In other groups of mice (n = 6 per group), amphotericin B served as positive control, infected animals as the disease control, while the naïve controls included normal animals; animals receiving only Iodium 30c or Alcohol 30c served as sham controls. The anti-leishmanial efficacy was assessed by determining the hepatic parasite load and analysing percentages of CD4+ and CD8+ T cells. Biochemical analysis and histological studies were performed to check any toxicities.Results Iodium-treated animals showed a significantly reduced parasite load (to 1503 ± 39 Leishman Donovan Units, LDU) as compared with the infected controls (4489 ± 256 LDU) (p < 0.05): thus, the mean therapeutic efficacy of Iodium 30c was 66.5%. In addition, the population of CD4+ and CD8+ T cells was significantly increased (p < 0.05) after treatment. No toxicity was observed, as evidenced from biochemical and histopathological studies of the liver and kidneys. Efficacy of Iodium 30c prophylaxis was 58.3%, while the therapeutic efficacy of amphotericin B was 85.9%.Conclusion This original study has shown that Iodium 30c had significant impact in controlling parasite replication in experimental VL, though the effect was less than that using standard pharmaceutical treatment.
Phenotypic Variability of an Inherited Pathogenic Variant in CIC Gene: A New Case Report in Two-Generation Family and Literature Review
Authors: Kishnani Sujata , Riley Kacie , Mikati Mohamad A. , Jiang Yong-hui 
Published: August 2020

AbstractCIC encodes capicua protein, a transcriptional repressor that is highly expressed in developing brains. A previous study reported pathogenic mutations in the CIC gene in five individuals with significant neurodevelopmental disorders of intellectual disability, epilepsy, and autism spectrum disorder. All these mutations are either de novo or likely due to germline mosaicism. Here we reported a pathogenic mutation (c.2694dupC; p.K899Qfs X32: NM_015125) in the CIC gene in three members of a two-generation family presenting with neurodevelopmental impairment but has significant phenotypic variability. Interestingly, loss of function variants of somatic origin are frequently found in cancers of brain and other organs. We summarized germline and somatic pathogenic or loss of function variants in CIC gene in public genome databases through in silico analysis and published literature. Our findings provided further evidence to support the review of haploinsufficiency of CIC in neurodevelopmental disorder, in addition to suggesting a strong modifier effect for the CIC mutations.
Complications and Factors Associated with Reoperation following Total Wrist Fusion
Authors: Hazewinkel M. H. J. , Lans Jonathan , Lunn Kiera N. , Garg Rohit , Eberlin Kyle R. , Chen Neal C. 
Published: August 2020

AbstractBackground Total wrist fusion can be elected to relieve pain in patients with osteoarthritis and rheumatoid arthritis. This study aimed to investigate the overall complications and the factors associated with reoperation and soft tissue complication after total wrist fusion.Methods We retrospectively identified adult patients who underwent total wrist fusion using Current Procedural Terminology (CPT) codes, International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) and verified these by medical chart review. We included patients (n = 215) who were treated at a single institutional system from January 1, 2002 to January 1, 2019. The mean age was 53.3 ± 15.0 years and the median follow-up was 6.1 years (interquartile range [IQR] =1.7–9.0). The most common indications for wrist fusion included inflammatory arthritis (n = 66, 31%), degenerative arthritis (n = 59, 27%), and posttraumatic arthritis (n = 47, 22%). All wrist fusions were performed using a dorsal fusion plate or dorsal spanning plate, either with a local autograft (n = 167, 78%), iliac crest autograft (n = 2, 1.0%), allograft (n = 7, 3.3%), a combination of both (n = 16, 7.4%), or without a graft (n = 23, 11%). We performed a multivariable logistic regression to evaluate factors associated with reoperation. In addition, we performed a similar analysis to identify the factors associated with soft tissue complication after total wrist fusion.Results Forty-one (19%) patients underwent reoperation at a median of 6.9 months (IQR = 3.9–18). The indications included symptomatic implants (n = 12, 27%), implant failures (n = 8, 20%), infections (n = 7, 17%), and nonunions (n = 6, 15%). In multivariable analysis, total wrist fusion of the dominant hand (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.1–4.7, p = 0.033) was associated with a higher reoperation rate. Soft tissue complications occurred in 20 patients (9.3%) consisting of hematomas (n = 8, 3.7%), observed blistering (n = 5, 2.3%), and observed wound dehiscence (n = 4, 1.9%). In multivariable analysis, smoking (OR: 2.5, CI: 0.95–6.4, p = 0.010) was independently associated with soft tissue complication after total wrist fusion. Seventy-two (33%) patients had a postoperative complication including symptomatic hardware (n = 16, 7.4%), implant failure (n = 11, 5.1%), infection (n = 11, 5.1%), nonunion (n = 8, 3.7%), and carpal tunnel syndrome (n = 4, 1.9%).Conclusion Roughly one-third (33%) of the patients undergoing total wrist fusion experience a postoperative complication and 19% of the patients underwent a reoperation. Total wrist fusion of the dominant hand results in higher reoperation rates. The risk of a soft tissue complication after total wrist fusion is increased in smokers.
Pyrocardan Trapeziometacarpal Joint Arthroplasty—Medium-Term Outcomes
Authors: Logan James , Peters Susan E. , Strauss Ruby , Manzanero Silvia , Couzens Gregory B. , Ross Mark 
Published: August 2020

AbstractObjective Pyrocardan trapeziometacarpal interposition implant is a free intra-articular spacer composed of pyrocarbon. This biconcave resurfacing implant, both ligament and bone-stock sparing, is indicated for use in early-to-moderate stage trapeziometacarpal osteoarthritis. It was hypothesized that the postoperative outcome measures of the Pyrocardan implant would be comparable to those seen with ligament reconstruction and tendon interposition (LRTI) surgeries and those reported by the designer of the implant, Phillipe Bellemère, but that strength would be greater than for LRTI.Methods In this prospective case series, 40 Pyrocardan implants were performed in 37 patients. Average age was 58 years (range: 46–71). Patients were assessed preoperatively, 3 months, 6 months, 1 year, 2 years, and beyond (long term) wherever possible.Results There have been no major complications or revision surgeries for the series. Average follow-up was 29 months (range: 12 months–7 years). Twenty-eight joints were assessed at over 2 years post index surgery. Outcome measure scores improved from preoperative assessment to the most recent follow-up equal or greater than 2 years. Average grip strength at 2 years was 30 kg, as compared with 19.6 kg in an age-matched cohort who underwent trapeziectomy and 25 kg in Bellemère's original series of Pyrocardan implants.Conclusions Pyrocardan interposition arthroplasty appears to be a safe, effective treatment for trapeziometacarpal arthritis. Patient-reported clinical outcomes were at least equivalent to LRTI and are comparable to Bellemère's original series. Grip and pinch strength appear to be better than LRTI.Level of Evidence This is a Level III, prospective observational cohort study.
The Anticoagulant and Nonanticoagulant Properties of Heparin
Authors: Beurskens Danielle M. H. , Huckriede Joram P. , Schrijver Roy , Hemker H. Coenraad , Reutelingsperger Chris P. , Nicolaes Gerry A. F. 
Published: August 2020

AbstractHeparins represent one of the most frequently used pharmacotherapeutics. Discovered around 1926, routine clinical anticoagulant use of heparin was initiated only after the publication of several seminal papers in the early 1970s by the group of Kakkar. It was shown that heparin prevents venous thromboembolism and mortality from pulmonary embolism in patients after surgery. With the subsequent development of low-molecular-weight heparins and synthetic heparin derivatives, a family of related drugs was created that continues to prove its clinical value in thromboprophylaxis and in prevention of clotting in extracorporeal devices. Fundamental and applied research has revealed a complex pharmacodynamic profile of heparins that goes beyond its anticoagulant use. Recognition of the complex multifaceted beneficial effects of heparin underscores its therapeutic potential in various clinical situations. In this review we focus on the anticoagulant and nonanticoagulant activities of heparin and, where possible, discuss the underlying molecular mechanisms that explain the diversity of heparin's biological actions.
Staged Buccal Mucosa Graft Urethroplasty for Proximal Hypospadias in Children: A Short- to Mid-Term Follow-Up Retrospective Study
Authors: Chen Sen , Li Yangqun , Ma Ning , Wang Weixin , Xu Lisi , Yang Zhe 
Published: August 2020

Abstract
Introduction The aim of this study is to report our experience with modified staged buccal mucosa graft urethroplasty for the repair of proximal hypospadias in children and adolescents.
Materials and Methods A total of 183 patients were treated at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between 2010 and 2019. The patients were grouped according to age: (1) within 1.5-year-old group, (2) prepuberty group (Tanner stage 1), and (3) puberty group.
Results In total, 153 patients were included in this study. Thirty-six patients had complications: seven after stage one; 29 after stage two; one patient had two complications. Maximum flow rates were 11.80 ± 1.46 mL/s in the 1.5-year-old group, 13.24 ± 2.61 mL/s in the prepuberty group, and 13.60 ± 2.20 mL/s in the puberty group (p = 0.199). Average flow rates were 6.86 ± 1.37, 7.94 ± 1.74, and 7.88 ± 1.22 mL/s, respectively (p = 0.203). The optimal hypospadias objective scoring evaluation score of 16 was seen in 117 patients (76%), the score of 15 in 23 patients (15%), 14 in 10 (7%), and 13 in 3 patients (2%). Patients with an uncomplicated treatment (no complication) had a higher clinical outcome than patients with a complication (15.8 ± 0.53 vs. 15.3 ± 0.97, with or without complication, p = 0.000). Multivariable analyses showed that previous treatment was closely related to the complication rate (p = 0.016).
Conclusion The modified procedure allows for two-stage repair of proximal hypospadias with good results with a low complication rate and good functional results. Delaying operation did not increase complication rates in our research.
Transition to Adulthood for Pediatric Moyamoya Patients
Authors: Scott R Michael , Smith Edward R. 
Published: August 2020

AbstractMoyamoya is a progressive arteriopathy of the intracranial vasculature, predominantly affecting the terminal branches of the internal carotid artery. Treatment is predicated on surgical revascularization to reduce the risk of stroke. For patients diagnosed and treated as children, it is important to recognize the long-term implications of the disease, for example, that moyamoya is treatable, but not curable. Pediatric moyamoya patients face unique challenges as they transition to adulthood as a consequence of the chronic nature of this disorder. Successful long-term care requires a strategy that incorporates ongoing longitudinal disease monitoring, coordination of care between physician teams, and anticipation of socioeconomic factors that change over time. This article provides an approach to transition care to adult caregivers for pediatric moyamoya patients with a specific focus on the three key stakeholders in the process: the neurosurgeon, the primary care physician, and the individual patient.
Far Lateral Craniotomy Closure Technique for Preservation of Suboccipital Musculature
Authors: Ali Muhammad Salman , Magill Stephen T. , McDermott Michael W. 
Published: August 2020

AbstractThe far lateral approach is used for accessing pathology at the craniovertebral junction but can be complicated by postoperative suboccipital muscle atrophy. In addition to significant cosmetic deformity, this atrophy can lead to head and neck pain and potentially could contribute to cranio-cervical instability. To address this issue, the senior author began using a single myocutaneous flap without a muscle cuff and securing it directly to the bone using predrilled holes in the bone that resemble a chevron. The method is described and illustrated with an example case. Results from seven consecutive cases are reported since the technique was adopted. Muscle atrophy was measured by calculating area at the level of the occipital condyle and compared with the contralateral side. No significant differences were noted. In conclusion, we have found this to be an excellent closure technique and wanted to present our initial results for consideration by other skull base surgeons.