Peripheral nerve injury is a complex condition with a variety of signs and symptoms such as numbness, tingling, jabbing, throbbing, burning or sharp pain. Peripheral nerves are fragile in nature and ...can easily get damaged due to acute compression or trauma which may lead to the sensory and motor functions deficits and even lifelong disability. After lesion, the neuronal cell body becomes disconnected from the axon's distal portion to the injury site leading to the axonal degeneration and dismantlement of neuromuscular junctions of targeted muscles. In spite of extensive research on this aspect, complete functional recovery still remains a challenge to be resolved. This review highlights detailed pathophysiological events after an injury to a peripheral nerve and the associated factors that can either hinder or promote the regenerative machinery. In addition, it throws light on the available therapeutic strategies including supporting therapies, surgical and non-surgical interventions to ameliorate the axonal regeneration, neuronal survival, and reinnervation of peripheral targets. Despite the availability of various treatment options, we are still lacking the optimal treatments for a perfect and complete functional regain. The need for the present age is to discover or design such potent compounds that would be able to execute the complete functional retrieval. In this regard, plant-derived compounds are getting more attention and several recent reports validate their remedial effects. A plethora of plants and plant-derived phytochemicals have been suggested with curative effects against a number of diseases in general and neuronal injury in particular. They can be a ray of hope for the suffering individuals.
Tobacco chewing and its consumption in other various forms are a common practice in India. The result of this is oral submucous fibrosis (OSMF) which itself considered a premalignant pathology and ...causes difficulty in mouth opening with poor quality of life. Various treatment strategies including medicine oral and topical, oral surgeries, physiotherapy, or combination have been suggested in the literature to improve mouth opening. The case presented here was suffering from OSMF and trismus and has undergone surgery including the release of oral fibrous bands and repair of oral defect with bilateral nasolabial flaps.
Background: The cavernous sinus (CS) is a complex anatomical structure that poses significant challenges to neurosurgeons performing surgical interventions in this region. A comprehensive ...understanding of the anatomy of the CS, including its relevant landmarks and structures, is crucial for successful surgical outcomes. Objective: This review aimed to provide a comprehensive overview of the anatomy of the CS, including relevant anatomical landmarks and structures, as well as surgical approaches for neurosurgeons. Methods: A literature search was conducted in electronic databases, including PubMed, Embase, and Scopus, using the keywords "cavernous sinus," "neuroanatomy," and "neurosurgery." Inclusion criteria included all articles published in the English language. Two independent reviewers screened the titles and abstracts, and relevant data was extracted from the included articles and synthesized for narrative synthesis. Results: A thorough comprehension of the eleven triangles in the parasellar region, medial fossa, and paraclival region is imperative for neurosurgeons to navigate complex anatomical structures during surgical approaches to the CS. These structures' anatomical relationships and spatial organization were summarized, along with an overview of relevant surgical approaches. Conclusion: The anatomy of the CS is complex and requires a thorough comprehension of the relevant anatomical landmarks and structures and surgical approaches. Neurosurgeons must comprehensively understand the eleven triangles in the parasellar region, medial fossa, and paraclival region to navigate the complex anatomical structures during surgical interventions effectively. This knowledge can enhance surgical precision and reduce the risk of complications, ultimately improving patient outcomes. KEY WORDS: Microsurgical Anatomy, Cavernous Sinus, Neurosurgical, Surgical Interventions.
Abstract
Background
Randomised controlled trials in surgery can be a challenge to design and conduct, especially when including a non-surgical comparison. As few as half of initiated surgical trials ...reach their recruitment target, and failure to recruit is cited as the most frequent reason for premature closure of surgical RCTs. The aim of this qualitative evidence synthesis was to identify and synthesise findings from qualitative studies exploring the challenges in the design and conduct of trials directly comparing surgical and non-surgical interventions.
Methods
A qualitative evidence synthesis using meta-ethnography was conducted. Six electronic bibliographic databases (Medline, Central, Cinahl, Embase and PsycInfo) were searched up to the end of February 2018. Studies that explored patients’ and health care professionals’ experiences regarding participating in RCTs with a surgical and non-surgical comparison were included. The GRADE-CERQual framework was used to assess confidence in review findings.
Results
In total, 3697 abstracts and 49 full texts were screened and 26 published studies reporting experiences of patients and healthcare professionals were included. The focus of the studies (24/26) was primarily related to the challenge of recruitment. Two studies explored reasons for non-compliance to treatment allocation following randomisation. Five themes related to the challenges to these types of trials were identified: (1) radical choice between treatments; (2) patients’ discomfort with randomisation: I want the best treatment for me as an individual; (3) challenge of equipoise: patients’ a priori preferences for treatment; (4) challenge of equipoise: clinicians’ a priori preferences for treatment and (5) imbalanced presentation of interventions.
Conclusion
The marked dichotomy between the surgical and non-surgical interventions was highlighted in this review as making recruitment to these types of trials particularly challenging. This review identified factors that increase our understanding of why patients and clinicians may find equipoise more challenging in these types of trials compared to other trial comparisons. Trialists may wish to consider exploring the balance of potential factors influencing patient and clinician preferences towards treatments before they start recruitment, to enable issues specific to a particular trial to be identified and addressed. This may enable trial teams to make more efficient considered design choices and benefit the delivery of such trials.
Purpose of Review
Direct-to-consumer telemedicine has vastly expanded in recent years, and urologic conditions are a common target for these companies. We aim to identify the urologic conditions ...being treated by direct-to-consumer telemedicine platforms and review the feasibility of adherence to evidence-based practice guidelines via this relatively new healthcare model.
Recent Findings
Erectile dysfunction, premature ejaculation, testosterone deficiency, and male infertility are being treated with direct-to-consumer telemedicine. Such platforms treating erectile dysfunction perform modestly in practice guideline adherence. Guidelines-based treatment of other urologic conditions via telemedicine is feasible, however, the treatment of these conditions through popular direct-to-consumer telemedicine platforms is largely unstudied.
Summary
The impact of direct-to-consumer telemedicine on the field of urology is vast and likely to continue to grow. Future studies should inspect direct-to-consumer telemedicine companies’ practice patterns and treatment outcomes to ensure the field’s standards of care are being met. Guidelines specific to the treatment of various urologic conditions via telemedicine are needed.
Background
Lumbar spinal stenosis (LSS) is a debilitating condition associated with degeneration of the spine with aging.
Objectives
To evaluate the effectiveness of different types of surgery ...compared with different types of non‐surgical interventions in adults with symptomatic LSS. Primary outcomes included quality of life, disability, function and pain. Also, to consider complication rates and side effects, and to evaluate short‐, intermediate‐ and long‐term outcomes (six months, six months to two years, five years or longer).
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, five other databases and two trials registries up to February 2015. We also screened reference lists and conference proceedings related to treatment of the spine.
Selection criteria
Randomised controlled trials (RCTs) comparing surgical versus non‐operative treatments in participants with lumbar spinal stenosis confirmed by clinical and imaging findings.
Data collection and analysis
For data collection and analysis, we followed methods guidelines of the Cochrane Back and Neck Review Group (Furlan 2009) and those provided in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).
Main results
From the 12,966 citations screened, we assessed 26 full‐text articles and included five RCTs (643 participants).
Low‐quality evidence from the meta‐analysis performed on two trials using the Oswestry Disability Index (pain‐related disability) to compare direct decompression with or without fusion versus multi‐modal non‐operative care showed no significant differences at six months (mean difference (MD) ‐3.66, 95% confidence interval (CI) ‐10.12 to 2.80) and at one year (MD ‐6.18, 95% CI ‐15.03 to 2.66). At 24 months, significant differences favoured decompression (MD ‐4.43, 95% CI ‐7.91 to ‐0.96). Low‐quality evidence from one small study revealed no difference in pain outcomes between decompression and usual conservative care (bracing and exercise) at three months (risk ratio (RR) 1.38, 95% CI 0.22 to 8.59), four years (RR 7.50, 95% CI 1.00 to 56.48) and 10 years (RR 4.09, 95% CI 0.95 to 17.58).
Low‐quality evidence from one small study suggested no differences at six weeks in the Oswestry Disability Index for patients treated with minimally invasive mild decompression versus those treated with epidural steroid injections (MD 5.70, 95% CI 0.57 to 10.83; 38 participants). Zurich Claudication Questionnaire (ZCQ) results were better for epidural injection at six weeks (MD ‐0.60, 95% CI ‐0.92 to ‐0.28), and visual analogue scale (VAS) improvements were better in the mild decompression group (MD 2.40, 95% CI 1.92 to 2.88). At 12 weeks, many cross‐overs prevented further analysis.
Low‐quality evidence from a single study including 191 participants favoured the interspinous spacer versus usual conservative treatment at six weeks, six months and one year for symptom severity and physical function.
All remaining studies reported complications associated with surgery and conservative side effects of treatment: Two studies reported no major complications in the surgical group, and the other study reported complications in 10% and 24% of participants, including spinous process fracture, coronary ischaemia, respiratory distress, haematoma, stroke, risk of reoperation and death due to pulmonary oedema.
Authors' conclusions
We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment. No clear benefits were observed with surgery versus non‐surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects. High‐quality research is needed to compare surgical versus conservative care for individuals with lumbar spinal stenosis.
Background: Molecular imaging is transforming medical diagnostics by providing insights into diseases at the molecular and cellular levels. This field merges advanced imaging technologies with ...molecular probes to visualize and quantify specific molecular targets in real-time, offering significant potential to improve surgical interventions’ precision and effectiveness, especially in robotic precision surgery. This review aims to thoroughly explore the applications and challenges of molecular imaging within this innovative surgical context.Method: A comprehensive search was conducted across PubMed, Science Direct, Web of Science, and Google Scholar databases up to October 2023, employing various keyword combinations such as “Molecular Imaging,” “Surgical Interventions,” “Robotic Surgery,” and “Robotic Precision Surgery.” The search culminated in selecting 11 of the most recent and pertinent studies for inclusion in this review.Results: Molecular imaging extends its utility from early diagnosis to therapy planning and implementation in precision surgery, enabling meticulous preoperative planning by offering detailed insights into tumor molecular characteristics. This enhances diagnostic precision, facilitating a more informed and targeted robotic surgical strategy. By visualizing specific molecular markers within tissues, molecular imaging allows for precise targeting of pathological sites, improving tumor resection accuracy while sparing healthy tissues. Its real-time capability delivers dynamic information during surgery, aiding surgeons in modifying their techniques in response to the changing molecular profile of tissues. Nonetheless, challenges such as spatial resolution limitations and safety concerns associated with molecular probes need addressing to refine molecular imaging’s application in robotic precision surgery. Bridging the gap between medical device innovations and tracer-based molecular imaging strategies is essential for a holistic approach to precision surgery.Conclusion: Integrating molecular imaging with robotic precision surgery represents a significant shift in surgical practices, offering real-time, high-resolution insights into molecular targets. This convergence promises to redefine the surgical field, enhancing patient outcomes and reducing procedural invasiveness. Overcoming current challenges remains imperative for its successful clinical adoption, with ongoing research and technological developments poised to usher in a new era of precision medicine and surgery.
Introducción: La isquemia cerebral es una de las complicaciones perioperatorias más catastróficas. En la actualidad, existen diversos dispositivos no invasivos para la detección intraoperatoria de ...isquemia cerebral. Objetivo: Realizar una revisión sistemática de la literatura con el fin de evaluar la validez diagnóstica de estos métodos para detectar isquemia cerebral intraoperatoria bajo anestesia general, ya que hasta ahora no se cuenta con un estándar de oro para estos pacientes.
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