In this letter to the editor, we discuss the article by Bigdon et al., published recently in the Journal of Orthopaedic Surgery and Research, about their accurate single-centre cohort study of 8000 ...vertebral fractures in 4772 patients. As the complication rate of this cohort is low, it seems that severe trauma patients needing damage control resuscitation/procedures may have undergone damage control in the first treating hospital before being transferred to the trauma centre. It will be interesting to see how both activity and health trends within the ageing population will change osteoporotic occurrence of fractures and enable more conservative trends versus operative stabilization to continue an active life even in the seventh or eighth decade.
Dear Editor,
Concerning the article of Bollano E et al. “Surgical treatment of uncomplicated Pilonidal Sinus with a simple closed technique” has been gathering our attention. In this LTE, we would ...like to critically discuss some of the author's statements. Firstly, the stated pathophysiology of PSD is an outdated theory. Furthermore, primary midline closure, as postulated by the author, is not the surgical procedure of first choice, as several large reviews have shown.
The letter discusses the rationale behind adopting the simple closed technique, highlighting its efficacy and potential advantages. By presenting data from our experiences in Albania, we aim to contribute valuable insights to the global discourse on pilonidal sinus treatment.
This letter is a noteworthy addition to AJTES, offering fresh insights into the treatment landscape of pilonidal sinus. We trust the editorial team will find the content aligned with the journal's objectives and scope.
Your consideration of this submission is highly appreciated, and we look forward to the possibility of contributing to the journal's ongoing dialogue on innovative surgical approaches.
Purpose of Review
We review the relevance of quantitative sensory testing (QST) in light of acute and chronic postoperative pain and associated challenges.
Recent Findings
Predicting the occurrence ...of acute and chronic postoperative pain with QST can help identify patients at risk and allows proactive preventive management. Generally, central QST testing, such as temporal summation of pain (TSP) and conditioned pain modulation (CPM), appear to be the most promising modalities for reliable prediction of postoperative pain by QST. Overall, QST testing has the best predictive value in patients undergoing orthopedic procedures.
Summary
Current evidence underlines the potential of preoperative QST to predict postoperative pain in patients undergoing elective surgery. Implementing QST in routine preoperative screening can help advancing traditional pain therapy toward personalized perioperative pain medicine.
Our understanding of pilonidal sinus disease (PSD) is based on a paper published 29 years ago by Karydakis. Since then, surgeons have been taught that hair more easily penetrates wet skin, leading to ...the assumption that sweating promotes PSD. This postulate, however, has never been proven. Thus we used pilocarpine iontophoresis to assess sweating in the glabella sacralis. 100 patients treated for PSD and 100 controls were matched for sex, age and body mass index (BMI). Pilocarpine iontophoresis was performed for 5 min, followed by 15 min of sweat collection. PSD patients sweated less than their matched pairs (18.4 ± 1.6 µl vs. 24.2 ± 2.1 µl, p = 0.03). Men sweated more than women (22.2 ± 1.2 µl vs. 15.0 ± 1.0 µl in non-PSD patients (p < 0.0001) and 20.0 ± 1.9 µl vs. 11.9 ± 2.0 µl in PSD patients (p = 0.051)). And regular exercisers sweated more than non-exercisers (29.1 ± 2.9 µl vs. 18.5 ± 1.6 µl, p = 0.0006 for men and 20.7 ± 2.3 µl vs. 11.4 ± 1.4 µl, p = 0.0005 for women). PSD patients sweat less than matched controls. Thus sweating may have a protective effect in PSD rather than being a risk factor.
Anemia, iron deficiency and other hematinic deficiencies are a major cause of perioperative transfusion needs and are associated with increased morbidity and mortality. Anemia can be caused either by ...decreased production of hemoglobin or red blood cells or by increased consumption and blood loss. Decreased production can involve anything from erythropoietin or vitamin B12 insufficiency to absolute or functional lack of iron. Thus, to achieve the goal of patient blood management, anemia must be addressed by addressing its causes. The traditional parameters to diagnose anemia, despite offering elaborate options, are not ideally suited to giving a simple overview of the causes of anemia, e.g., iron status for erythropoiesis, especially during the acute phase of inflammation, acute blood loss or iron deficiency. Reticulocyte hemoglobin can thus help to uncover the cause of the anemia and to identify the main factors inhibiting erythropoiesis. Regardless of the cause of anemia, reticulocyte hemoglobin can also quickly track the success of therapy and, together with the regular full blood count it is measured alongside, help in clearing the patient for surgery.
The Complex Femoral injuries after Hippopotamus Bite Kovalenko, Fedor; Vassiliu, Pantelis; Degiannis, Konstantinos ...
Albanian journal of trauma and emergency surgery (Online),
07/2021, Letnik:
5, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Introduction. Attacks by large animals, which lead to a critical patient condition, have not been systematically and statistically analyzed in the previous literature. Some papers about animal ...attacks are case reports and address fatal cases. Hippopotamus bite injury is a major trauma associated with complications.
Case report. In 2018, an American woman celebrating her 37th birthday in Zimbabwe embarked on a river rafting trip. After the hippopotamus bite, the patient had extensive soft tissue injuries and a comminuted fracture of the right femur. It was undertaken extensive multiple wound debridement and the femur was nailed as the site of entrance of the nail was away from the soft tissue injuries.
Conclusion. Usually, hippopotami avoid contact with people. Similar to many wild animals, hippopotami can attack in anticipation of danger, especially when protecting their offspring. In the present case, the inflicted injury is severe and has a combined character.
Introduction: In the last two centuries, many theories have been proposed to explain the origin of pilonidal sinus disease (PSD) – congenital and acquired.
Materials and Methods: A PubMed literature ...review was conducted and looked at different proposed theories on the origin of PSD; this overview was then compared to research results from more recent studies.
Results: Initially it was postulated, that PSD was of embryonic origin. This however changed during World War II as more 78.000 American soldiers were diagnosed and treated for PSD. Thereafter, the perception of the origin of PSD changed to an acquired one. New data has shown that short hair fragments, which have fallen from the scalp may be the origin of PSD – therefore disproving the theory of folliculitis and fatty gland obstruction.
Conclusion: These new findings may explain why recurrences/new diseases occur within follicle-free areas – such as scars and without any preceding infection. This may aid in the prevention of PSD.
Even though the post-operative outcome varies greatly among patients with nodal positive colon cancer (UICC stage III), personalized prediction of systemic disease recurrence is currently ...insufficient. We investigated in a retrospective setting whether genetic and immunological biomarkers can be applied for stratification of distant metastasis occurrence risk.
Eighty four patients with complete resection (R0) of stage III colon cancer from two clinical centres were analysed for genetic biomarkers: microsatellite instability, oncogenic mutations in KRAS exon2 and BRAF exon15, expression of osteopontin and the metastasis-associated genes SASH1 and MACC1. Tumor-infiltrating CD3 and CD8 positive T-cells were quantified by immunocytochemistry. Results were correlated with outcome and response to 5-FU based adjuvant chemotherapy, using Cox's proportional hazard models and integrative two-step cluster analysis.
Distant metastasis risk was significantly correlated with oncogenic KRAS mutations (p = 0.015), expression of SASH1 (p = 0.016), and the density of CD8-positive T-cells (p = 0.007) in Kaplan-Meier analysis. Upon multivariate Cox-regression analysis, KRAS mutation (p = 0.008) and density of CD8-positive TILs (p = 0.009) were retained as prognostic parameters for metachronous distant metastasis. Integrative two-step cluster analysis was used to combine all genetic markers, allowing stratification of patient subgroups. Post-operative distant metastasis risk ranged from 31% (low-risk) to 41% (intermediate), and 57% (high-risk) (p = 0.032). Increased expression of osteopontin (p = 0.019) and low density of CD8-positive T-cells (p = 0.043) were significantly associated with unfavourable response to 5-FU.
Integrative biomarker analysis allows stratification of stage III colon cancer patients for the risk of metastatic disease recurrence and may indicate response to 5-FU. Thus, biomarker analysis might facilitate the use of adjuvant therapy for high risk patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
: No current nationwide consensus exists on pilonidal disease (PD) treatment in Switzerland and Austria. The objective of this study was to assess and compare the spectrum of PD treatment strategies ...in Switzerland and Austria.
: A survey including 196 certified institutions (Switzerland,
= 99 and Austria,
= 97) was performed. Treatment strategies for both chronic and acute pilonidal disease were investigated, as well as evolution of treatment over the last 20 years.
: In total, 92 of 196 (47%) hospitals participated in the survey. Recurrence rate (20%) was similar between the two countries. In acute pilonidal disease, a two-stage approach with incision and drainage as the first step was preferred over a one-stage procedure in both countries. In Austria, all patients with chronic pilonidal disease were treated as inpatients, whereas 28% of patients in Switzerland were treated on an outpatient basis (
= 0.0019). Median length of hospital stay was double in Austria (four days) compared to Switzerland (two days;
< 0.001). Primary resection and off-midline closure (
= 0.017) and the use of tissue flaps (
= 0.023) were performed more commonly in Austria than in Switzerland. Minimally invasive techniques were performed more often in Switzerland than in Austria (52% vs. 4%,
< 0.001). Overall, wide excision with secondary wound healing or midline closures declined over the last 20 years.
: Treatment strategies for chronic PD differ between Austria and Switzerland with more and longer inpatient care in Austria, increasingly minimally invasive approaches in Switzerland, and outdated procedures still being performed in both countries. Overall, heterogeneity of practice dominates in both countries.
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