bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experience Using Kaolin-Impregnated Sponge to Minimize Perioperative Bleeding in Norwood Operation
Authors: Shinkawa Takeshi , Holloway Jessica , Tang Xinyu , Gossett Jeffrey M. , Imamura Michiaki 
Published: November 2017

Purpose: A kaolin-impregnated hemostatic sponge (QuikClot) is reported to reduce intraoperative blood loss in trauma and noncardiac surgery. The purpose of this study was to assess if this sponge was effective for hemostasis during Norwood operation. Description: We conducted a retrospective review of patients undergoing Norwood operation in infancy between 2011 and 2016 at our institution. Evaluation: Of 31 identified Norwood operations, a kaolin-impregnated sponge was used intraoperatively in 15 (48%) patients. The preoperative profiles and cardiopulmonary bypass status were similar between the operations with or without kaolin-impregnated sponge. The comparison on each operative outcome between operations with or without kaolin-impregnated sponge showed that the intraoperative platelets, cryoprecipitate, and factor VII dosage were significantly less in the operations with kaolin-impregnated sponge (55 mL, 10 mL, 0 µg/kg vs 72 mL, 15 mL, 45 µg/kg; P = .03, .021, .019), as well as the incidence of perioperative bleeding complications (second cardiopulmonary bypass for hemostasis or postoperative mediastinal exploration, 0% vs 31%, P = .043). A logistic regression model showed that the nonuse of kaolin-impregnated sponge and longer aortic cross clamp time were associated with perioperative bleeding complication in univariable model ( P = .02 and .005). Conclusions: Use of kaolin-impregnated hemostatic sponge was associated with reduced blood product use and perioperative bleeding complications in Norwood operation at a single institution.
Feasibility of Biventricular Repair in Right Dominant Unbalanced Atrioventricular Septal Defect: A New Echocardiographic Metric to Refine Surgical Decision-Making
Authors: Lugones Ignacio , Biancolini María Fernanda , Biancolini Julio César , Dios Ana M. S. de , Lugones Germán 
Published: November 2017

Background: Unbalanced forms of atrioventricular septal defect continue to be challenging and present poor surgical outcomes. Echocardiographic indicators such as atrioventricular valve index, right ventricle/left ventricle inflow angle, and size of the ventricular septal defect have been identified as relevant discriminators that may guide surgical strategy. Our purpose is to describe another metric to refine surgical decision-making. Methods: We outline a geometrical description of the anatomic features of atrioventricular septal defect and describe equations that help explain the interplay between the main echocardiographic variables. Results: A new metric called “indexed ventricular septal defect” is defined as the size of the defect in relation to the valve diameter. We derive a final equation relating this index with the atrioventricular valve index and the right ventricle/left ventricle inflow angle. In the light of that equation, we discuss the interdependence of variables and employ data from a Congenital Heart Surgeons’ Society study to set the limits of the new index. Conclusion: Combined use of indexed ventricular septal defect and atrioventricular valve index might help clarify surgical decision-making in patients with mild and moderate unbalance (modified atrioventricular valve index between 0.2 and 0.39). For indexed ventricular septal defect smaller than 0.2, biventricular repair may be recommended. Between 0.2 and 0.35, this strategy could probably be achieved depending on other factors. However, other strategies should be considered for those patients showing an indexed ventricular septal defect between 0.35 and 0.5. For values above 0.5 to 0.55, univentricular palliation might be a reasonable strategy.
Surgical Management of Injuries Sustained from Grizzly Bear Maulings Treated in Vancouver, British Columbia
Authors: Mahabir Raman C , Olesen Peter R , Cannon Wendy G , Barré Nicole M , Snelling Charles Ft , Williamson J Scott , Courtemanche Douglas J 
Published: November 2017

Background Between January 1, 1992 and May 31, 1999, four patients underwent operation at Vancouver Hospital and Health Sciences Centre for injuries sustained in grizzly bear maulings. Purpose To document and discuss surgical diagnosis and treatment of grizzly bear attack victims. Methods Data were collected retrospectively from clinical charts. Results Injuries were characterized by scalp and tissue avulsions, puncture wounds, lacerations and fractures. On average, patients underwent eight operations. The mean hospital stay was 43 days. Despite irrigation, debridement and antibiotic therapy, patients developed wound colonizations or infections with multiple Gram-positive and -negative organisms. All four patients developed post-traumatic stress disorder necessitating psychiatric counselling and pharmacological treatment. Conclusions Grizzly bear maulings result in multiple injuries requiring careful management and complex reconstruction. Bacterial infections and post-traumatic stress disorder were common complications in this group of patients.
Long Term Complications of Orbital Floor Fracture Repair
Authors: Boulos Patrick R , Harris Patrick G , Cordoba Carlos , Ciaburro Hugo , Frenette Gilles 
Published: November 2017

Purpose To search for complications of orbital floor fracture repair that occur late postoperatively, to reveal their natural course and to attempt to associate the complications with variables that are possibly involved in their genesis. Methods A retrospective comparative case series of all orbital floor fracture repair cases (158 eyes) from 1983 to 1998 was done. Synthetic prostheses were tailored to the orbital floor in clinically significant fractures. Bone grafts were chosen for large defects, comminuted fractures or if other reconstruction (eg, sinus) was required. Variables studied included age, sex, trauma to surgery time lag, surgeon, fracture type, length of surgery, antibiotics, prosthesis material, hospital stay and follow-up. These variables were tested for association with the following complications: altered vision, diplopia, dysesthesia, ectropion, pain, infection, enophthalmos and extrusion. Occurrence and resolution data were collected. Results One of four complications (often more than one per eye) resolved without surgery. Reintervention resolved one of three complications. Of all patients, 39.2% remain with long term unresolved complications. Altered vision is more probable with older patients and with longer surgeries. Diplopia was least likely to occur with orbitozygomatic or panfacial fractures and more probable with bone grafts. Ectropion and epiphora increased with a fracture's severity. Pain was mostly attributable to bone grafts. Enophthalmos was mainly due to large or comminuted fractures. Infection and extrusion were rare. Sex, surgeon and trauma to surgery time lag had no bearing on the incidence of complications. Conclusions Delaying surgery did not seem to influence complications. Lessening ocular manipulation during longer surgeries may reduce vision changes. The only truly modifiable variable was the material used for orbital floor repair. Alloplastic prostheses should be used, but if large or comminuted fractures are involved, bone grafting is an interesting first choice.
Measuring quality of life in women undergoing surgery for breast hypertrophy
Authors: Kerrigan Carolyn L , Schwarz Gaston , Charbonneau Roland 
Published: November 2017

The purpose of the present study was to describe the outcomes associated with reduction mammaplasty in terms of physical parameters and health-related quality of life. A prospective cohort study was designed and included women undergoing bilateral breast reduction surgery at the Royal Victoria Hospital, Montreal, Quebec, who consented to participate. Women were evaluated preoperatively for symptoms, physical parameters, quality of life (Short Form [SF]-36 and Multidimensional Body Self Relations Questionnaire [MBSRQ]) and general demographic characteristics that were identified as potential confounders. Postoperatively, women were re-evaluated at six months for symptoms, physical parameters and quality of life. A total of 74 women were entered in the study. Their average age was 32.3 years, and the mean mass of resected volume per breast was 630 g. There was a statistically significant improvement in symptoms six months after surgery (P<0.05). There was also a statistically significant improvement in the physical component summary scale of the SF-36 and several additional subscales: bodily pain, physical functioning, role-physical, and vitality. The MBSRQ subscale of appearance evaluation was significantly increased (2.69 compared with 3.12, P=0.000), whereas the appearance orientation subscale was unchanged. The amount of tissue removed did not appear to correlate with the change in physical symptoms or health-related quality of life resulting from the surgery. This study showed significant improvement in physical and psychological aspects of health-related quality of life in women undergoing reduction mammaplasty.
Changes in sleep architecture after burn injury: ‘Waking up’ to this unaddressed aspect of postburn rehabilitation in the developing world
Authors: Masoodi Zulqarnain , Ahmad Imran , Khurram Fahud , Haq Ansaul 
Published: November 2017

Background Changes in sleep architecture are common phenomena observed in post-traumatic patients; such altered sleeping patterns have negative implications on various phases of rehabilitation. Sleep is an essential process, without which one cannot function effectively and, hence, any aberrations in the quality of sleep in such patients need to be critically analyzed. Objective To probe the quality of sleep in postburn patients at one year compared with a group of adequately matched controls. Methods Quality of sleep in postburn patients at one year was measured using the Pittsburg Sleep Quality Index questionnaire and compared with a group of adequately matched controls. Data were tabulated and subjected to statistical analysis using Pearson's χ2 test. Results The relationship between the postburn state and sleep disturbances was found to be statistically significant. Other relevant parameters are also highlighted and discussed. Discussion Sleep is one of aspect of functioning that may be least taken into account by professionals during the phase of postburn rehabilitation because more obvious threats receive preferred treatment. Unless these problems are dealt with in the postburn period, rehabilitation can never be complete. Conclusion Postburn patients experience significant changes in sleep architecture, which need to be taken into account to enable complete rehabilitation of the patient.
Operative trends and physician treatment costs associated with Dupuytren's disease in Canada
Authors: Liu Wendy , O'Gorman David B , Gan Bing Siang 
Published: November 2017

Purpose To examine treatment trends and costs associated with Dupuytren's disease (DD) in Canada. Methods Data regarding fasciectomies, fasciotomies and digit amputations performed for DD from 2005 to 2010 were extracted from the Canadian Institute for Health Information database. The data were analyzed according to year, sex and five-year age groups. The estimated annual physician reimbursement costs for DD in Ontario were calculated using Ontario Health Insurance Plan billing information and the 2010 Physician Schedule of Benefits. Results The number and rate of fasciectomies remained stable from 2005 to 2009 (mean of 4067 and 1.24 per 10,000, respectively), but increased in the 2009/2010 fiscal year (to 4458 and 1.32 per 10,000). The number of fasciotomies increased from 133 in 2005/2006 to 201 in 2008/2009, but dropped to 183 in 2009/2010. The mean number of amputations remained stable (12 procedures). The ratio of males to females undergoing fasciectomies remained stable (4:1). The highest rate of fasciectomies was performed for the age groups 65 to 69 years and 70 to 74 years. Estimated mean physician remuneration for DD in Ontario remained stable ($3.2 million per annum). Discussion The results regarding patient demographics are comparable with results from previous literature. There was a trend toward an increasing number of fasciectomies and fasciotomies annually, with fasciotomies increasing faster than fasciectomies, which is reflective of the aging population and the recent attention to fasciotomies in the literature. The present study was the first to investigate treatment trends and physician reimbursement costs for the management of DD in Canada.
Improved external rotation with concomitant reverse total shoulder arthroplasty and latissimus dorsi tendon transfer: A systematic review
Authors: Wey Aaron , Dunn John C , Kusnezov Nicholas , Waterman Brian R , Kilcoyne Kelly G 
Published: November 2017

Background: In conjunction with reverse total shoulder arthroplasty (RSA), latissimus dorsi and teres major (LD-TM) transfer has been advocated in the setting of combined loss of elevation and external rotation. The purpose of this systematic review is to summarize the clinical outcomes following RSA with LD-TM transfer. Methods: A search of PubMed, EMBASE, CINAHL, Medline, and Cochrane databases was performed between January 1, 1990 and March 1, 2016 and included articles related to outcomes following RSA with LD-TM transfer. Primary outcomes of interest were constant score, shoulder range of motion, and patient satisfaction. Secondary outcomes of interest included subjective shoulder value, simple shoulder test, activities of daily living requiring external rotation, and visual analog pain score. Additional outcomes evaluated included complications and reoperations. Frequency-weighted values of outcome data were utilized. Results: Five level IV studies involving 98 shoulders met the inclusion criteria. The mean age of the cohort was 69.1 ± 5.19 years (range 47–85). RSA with LD-TM transfer was performed for rotator cuff arthropathy (94%) or proximal humerus fracture (6%). The average follow-up was 44.5 ± 10.38 months (range 12–105 months). The constant score improved from 28 to 65 ( p < 0.0005). Active external rotation improved from −7.4° to 22.9° ( p < 0.0005). There was a 22.4% overall complication rate, including dislocation (5.1%), infection (5.1%), and transient nerve palsy (3.4%). Conclusion: Patients undergoing RSA with LD-TM transfer in the setting of loss of external rotation demonstrate reliable clinical improvements in shoulder function with complication rates which are comparable to RSA alone.
Does preoperative mental health affect length of hospital stay and functional outcomes following arthroplasty surgery? A registry-based cohort study
Authors: Singleton Neal , Poutawera Vaughan 
Published: November 2017

Aim: It has been reported in the literature that patients with poor preoperative mental health are more likely to have worse functional outcomes following primary total hip and knee arthroplasty. We could find no studies investigating whether preoperative mental health also affects length of hospital stay following surgery. The aim of this study was to determine whether preoperative mental health affects length of hospital stay and long-term functional outcomes following primary total hip and knee arthroplasty. We also aimed to determine whether mental health scores improve after arthroplasty surgery and, finally, we looked specifically at a subgroup of patients with diagnosed mental illness to determine whether this affects length of hospital stay and functional outcomes after surgery. Method: Through a review of prospectively collected regional joint registry data, we compared preoperative mental health scores (SF-12 MH) with length of hospital stay and post-operative (1 and 5 years) functional outcome scores (Oxford and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)) in 2279 primary total hip and knee arthroplasty surgeries performed in the Bay of Plenty District Health Board between 2006 and 2010. Results: Based on Pearson product–moment correlation coefficients, there was a significant correlation between preoperative mental health scores and post-operative Oxford scores at 1 year as well as post-operative WOMAC scores at both 1 and 5 years. There was no significant correlation between preoperative mental health and length of hospital stay. Mental health scores improved significantly after arthroplasty surgery. Those patients with a formally diagnosed mental illness had significantly worse preoperative mental health and function scores. Following surgery, they had longer hospital stays although their improvement in function was not significantly different to those without mental illness. Conclusion: The results of this study support reports in the literature that there is a correlation between preoperative mental health and long-term functional outcomes following primary total hip and knee arthroplasty. Patients with poor preoperative mental health are more likely to have worse functional outcomes at 1 and 5 years following surgery. No correlation between preoperative mental health and length of hospital stay was identified. Mental health scores improved significantly after surgery. Patients with mental illness had longer hospital stays and despite worse preoperative mental health and function had equal improvements in functional outcomes.
Effect of sodium hyaluronate/carboxymethyl cellulose (Guardix-sol) on retear rate and postoperative stiffness in arthroscopic rotator cuff repair patients: A prospective cohort study
Authors: Jeong Jeung Yeol , Chung Pill Ku , Yoo Jae Chul 
Published: November 2017

Purpose: Hyaluronate-based anti-adhesive agents are expected to enhance rotator cuff healing; however, their effect on the incidence and extent of postoperative complications such as stiffness and retears has not been investigated. Methods: From July 2012 to February 2013, 80 patients undergoing arthroscopic rotator cuff repair surgery were prospectively enrolled. Forty patients were assigned to the control group, while the other 40 were assigned to the injection group and received a Guardix-sol injection immediately after surgery. Passive range of motion, pain visual analog scale, and functional score were assessed at 8 weeks, 6 months, and 24 months postoperatively. Gliding motion between the deltoid muscle and the greater tuberosity of the proximal humerus was evaluated using ultrasonography at 2 and 8 weeks postoperatively, and tendon integrity was evaluated using magnetic resonance imaging at 6 months postoperatively. Results: We found no significant difference between the groups regarding gliding motion at 2 weeks postoperatively. However, at 8 weeks, the incidence of poor gliding motion was 2.5% and 15% for the injected patients and control group, respectively, which was statistically significant. At 6 months after surgery, the retear rate between the two groups was not statistically significant. We found no statistically significant difference between the two groups regarding retear rate and clinical score throughout the follow-up period. We noted no complications related to the use of Guardix-sol. Conclusions: Patients who received the Guardix-sol injection showed improved gliding motion between the deltoid muscle and the greater tuberosity in the early postoperative period.
Analysis of functional outcome of Hoffa fractures: A retrospective review of 32 patients
Authors: Trikha Vivek , Das Saubhik , Gaba Sahil , Agrawal Prabhat 
Published: November 2017

Purpose: Hoffa fractures are uncommon intra-articular fractures of femoral condyle in coronal plane. The purpose of our study is to assess radiologic and functional outcome in operatively treated Hoffa fractures. Methods: We retrospectively reviewed 32 patients of isolated Hoffa fracture from January 2010 to March 2015. All were treated with open reduction and internal fixation using lateral approach for lateral Hoffa and medial approach for medial Hoffa fracture. Cancellous screws in lag mode and/or antiglide plate were employed for fixation in accordance with fracture anatomy. All patients were subjected to aggressive physical therapy postoperatively. Knee Society Score (KSS), International Knee Documentation Committee Score (IKDC), and Knee range of motion (ROM) were documented at final follow-up for functional evaluation. Results: All fractures united by mean time of 11.56 ± 1.5 weeks. No evidence of subsequent displacement or fixation failure, arthritis, Avascular necrosis (AVN) of femoral condyle was elicited in any of the patients. Documented mean KSS and mean IKDC Score at final follow-up were 83.19 ± 8.43 and 81.62± 6.95, respectively. ROM at final follow-up was ranging from 0° to mean 116.41° ± 13.98°. Complications included stiffness of the involved knee in four patients, including one patient who developed infection and had to undergo implant removal after fracture union. Conclusion: Operative treatment of Hoffa fractures yields fairly good functional outcome. One must endeavor to achieve adequate intraoperative exposure and stable congruous articular reconstruction. Early aggressive physical therapy is a harbinger of optimal outcome.
Bone–Patellar Tendon–Bone Versus Hamstring Tendon Autografts for Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review of Overlapping Meta-analyses
Authors: Schuette Hayden B. , Kraeutler Matthew J. , Houck Darby A. , McCarty Eric C. 
Published: November 2017

Background: Previous meta-analyses have compared bone–patellar tendon–bone (BPTB) with hamstring tendon (HT) autografts for primary anterior cruciate ligament reconstruction (ACLR). Purpose: To conduct a systematic review of overlapping meta-analyses comparing BPTB with HT autografts for ACLR to determine which meta-analyses provide the best available evidence. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by searching the PubMed and Cochrane Library databases. Search words included “anterior cruciate ligament” AND “patellar tendon” AND “hamstring tendon” AND “meta-analysis.” Results were reviewed to determine study eligibility. Patient outcomes and postoperative complications were extracted from the included meta-analyses. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) scores. The Jadad decision algorithm was then utilized to determine which meta-analyses provided the best level of evidence. Results: Sixteen meta-analyses containing an average of 1396 patients met the eligibility criteria. Most studies found BPTB autografts to provide superior stability but more postoperative complications, such as anterior knee pain and kneeling pain. Studies by Gabler et al (2016), Mohtadi et al (2011), and Xie et al (2015) received the highest Oxman-Guyatt and QUOROM scores, and therefore, these meta-analyses proved to provide the highest level of evidence. Additionally, Xie et al was selected as the highest-quality study in this systematic review based on the Jadad decision algorithm. Conclusion: The current best evidence suggests that ACLR with BPTB autografts provides superior static knee stability and that there are fewer postoperative complications in ACLR with HT autografts.