Objective To determine whether longitudinal measurements of fecal S100A12, a fecal marker of intestinal inflammation, can identify very low birth weight infants at risk for necrotizing enterocolitis ...(NEC). Study design This prospective study included 145 preterm infants with birth weight <1500 g. Meconium and stool samples (n = 843) were collected prospectively on alternate days for 4 weeks, and fecal S100A12 and calprotectin were measured by enzyme-linked immunosorbent assay. Results Eighteen patients (12.4%) developed NEC. Gestational age and birth weight were significantly lower in the patients with NEC compared with unaffected reference infants. Fecal S100A12 levels were significantly higher in patients with severe NEC at onset of disease and also, in contrast to fecal calprotectin, at 4-10 days before onset of NEC compared with unaffected reference infants (ideal cutoff value, 65 μg/kg; sensitivity, 0.76; specificity, 0.56). Conclusions Fecal S100A12 level may be a helpful marker for predicting disease severity and early risk assessment for subsequent development of NEC. However, the use of fecal S100A12 as a predictive biomarker for NEC in very low birth weight infants may be limited due to a high interindividual and intraindividual variability in S100A12 fecal excretion.
Background Endoscopic transluminal débridement of infected pancreatic necrosis has been proved to be an important alternative to surgical débridement. Recently, endoscopic vacuum-assisted closure ...(EVAC) has been described as a new effective treatment option in upper intestinal anastomotic leaks. Objective To test whether the EVAC can be applied to transgastrically accessible infected cavities. Design Single-center case study. Setting Academic medical center. Patients Two patients with necrotizing pancreatitis. Main Outcome Measurement Successful closure of leak. Results We successfully applied EVAC to treat transgastrically accessible necrotic cavities. Limitations Small case number. Conclusions EVAC might be an important additional endoscopic treatment option for infected pancreatic necrosis, especially if established endoscopic treatment options fail.
Abstract Background The correction of coagulopathy with fresh frozen plasma (FFP) is one of the main issues in the treatment of multiple-injured patients. Infectious and septic complications ...contribute to an adverse outcome in multiple-injured patients. Here, we investigated the role of FFP in the development of inflammatory complications given within the first 48 hours. Methods A total of 2033 patients with multiple injuries and an Injury Severity Score greater than 16 points and aged 16 years or older were included. The population was subdivided into 2 groups: those who received FFP and those who did not. The data were analyzed using SPSS version 22.0. Associations between the data were tested using Pearson correlation. Independent predictivity was analyzed by binary logistic regression and multivariate regression. Data were considered as significant if P < .05. Results The prothrombin time at admission was significantly lower (68.5% ± 23.3% vs 81.8% ± 21.0% normal; P < .001) in the group receiving FFP. The application of FFP led to a more severe systemic inflammatory response syndrome (SIRS) grade (3.0 ± 1.2 vs 2.2 ± 1.4; P < .001), to a higher infection rate (48% vs 28%; P < .001), and to a higher sepsis rate (29% vs 13%; P < .001) in the patients receiving FFP. The correlations between SIRS and the incidence of infections and sepsis increased with the amount of FFP applied ( P < .001). Conclusions Treatment with FFP of bleeding patients with multiple injuries enhances the risk of SIRS, infection, and sepsis; however, a multifactorial genesis has to be postulated.
Open Technique for In Situ Subtalar Fusion Wirth, Stephan H; Zimmermann, Stefan M; Viehöfer, Arnd F
Foot and ankle clinics,
09/2018, Letnik:
23, Številka:
3
Journal Article
Recenzirano
The subtalar joint plays an important role for the hindfoot when accommodating during gait. Joint degeneration may be caused by posttraumatic, inflammatory, and pathologic biomechanical changes. Once ...conservative treatment has failed, subtalar fusion should be considered. The indication for surgery is based on thorough clinical and radiographic evaluation. Several techniques for subtalar fusion are published in literature. This article aims to describe a technique for in situ arthrodesis of the subtalar joint, paying special attention to biomechanical aspects as well as preoperative clinical and radiological work-up.
Category:
Hindfoot
Introduction/Purpose:
Different factors are well known influencing the development of adult acquired flatfoot (AAF) deformity. So far less attention was paid to the lateral ...ligament complex. The idea that the anterior talofibular ligament (ATFL) probably influences AAF could be obvious concerning its anatomical course. Goal of this study is to assess the influence of ATFL on AAF and on operative AAF correction by lateral calcaneal.
Methods:
We reviewed all patients that undergone lateral calcaneal lengthening in AAF from 01/01/2008 to 07/31/2018 in our clinic. Patients were grouped in patients with intact ATFL and in those with injured ligament. Two independent readers performed assessment of common radiographic flatfoot parameters in preoperative and postoperative radiographs.
Results:
Statistical significant difference between two groups could be observed for preoperative talonavicular uncoverage angle (p=0.018) and talocalcaneal angle (p=0.032), with more severe AAF in patients with injured ATFL. The other common radiographic parameters showed no significant difference, although a tendency to a more severe AAF could be observed within the group with damaged ATFL. No difference could be observed in surgical outcome or consistency after lateral calcaneal lengthening between two groups.
Conclusion:
ATFL seems to take impact in AAF concerning talonavicular uncoverage angle and talocalcaneal angle. In patients undergoing lateral calcaneal lengthening the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result.
To determine which angiography-based algorithm delivers the most precise results in comparison with direct measurements at intravascular ultrasonography (US) and evaluate their influence on the ...resulting balloon size for treatment.
Thirty patients with untreated superficial femoral artery stenosis underwent digital subtraction angiography (DSA) and intravascular US before intervention. Two experienced radiologists measured twice the native vessel lumen diameter and the degree of stenosis with all algorithms and modalities in a predefined vessel segment that was perceived to be unaffected. On the basis of the measurements of the vessel lumen diameter, a suitable balloon size for treatment of the lesion was calculated.
The mean vessel diameter was 5.7 mm for intravascular US, 6.6 mm for caliper calibration, 6.0 mm for calibration of the catheter tip, and 4.7 mm for visual estimation. Selected balloon sizes were 6.0 mm, 7.0 mm, 6.0 mm, and 5.0 mm, respectively. The mean percentage of stenosis was 78.8% for intravascular US, 81.6% for caliper calibration, 79.7% for catheter calibration, and 88.8% for visual estimation. Intermethod correlation was best for intravascular US and calibration of a catheter tip (0.881, P < .0001).
Measurements on DSA equipment calibrated to a catheter tip correlate best with direct intravascular measurements. Visual estimation can lead to underestimation of the true vessel size and overestimation of stenosis.
Category:
Bunion
Introduction/Purpose:
An optimal osteotomy angle can avoid shortening of the first metatarsal bone after hallux valgus surgery and therefore reduce the risk of ...transfer-metatarsalgia. Up to date the osteotomy is performed free-hand without guidance and is therefore prone to unwanted variability in accuracy. The purpose of the present ex-vivo study was to investigate whether overlaying a hologram (augmented reality, AR) would improve accuracy of the distal osteotomy during hallux valgus surgery.
Methods:
A polyamide foot skeleton was constructed based a CT scan of a cadaveric foot and covered with medical silicon soft tissue. Three different polyamide first metatarsals were inserted to simulate a light, moderate and severe hallux valgus deformity. Distal Osteotomies of the first metatarsals were performed by two surgeons with different levels of surgical experience each with (AR, n=15x2) or without (controls, n=15x2) overlay of a hologram depicting an angle of osteotomy perpendicular to the second metatarsal in the transverse plane. Subsequently, the deviation to the plumb line of the second metatarsal in the transverse plane of all 60 osteotomies angles were optically measured and statistically analyzed.
Results:
Overall, the AR-guided osteotomies were more accurate (4.9 ± 4.2°) compared to the freehand cuts (6.7± 6.1°) by tendency (p=0.2). However, while the inexperienced surgeon performed more accurate osteotomies with AR with a mean angle of 6.4± 3.5° compared to freehand 10.5 ± 5.5° (p=0.02), no significant difference was noticed for the experienced surgeon with an osteotomy angle of around 3° in both cases.
Conclusion:
This pilot-study suggests that augmented reality guided osteotomies can potentially improve accuracy during hallux valgus surgery, particularly for less experienced surgeons. However, clinical studies are needed to investigate the clinical benefit of augmented reality in hallux valgus surgery.
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