Therapeutic Validity and Effectiveness of Preoperative Exercise on Functional Recovery after Joint Replacement: A Systematic Review and Meta-Analysis

Background: Our aim was to develop a rating scale to assess the therapeutic validity of therapeutic exercise programmes. By use of this rating scale we investigated the therapeutic validity of therapeutic exercise in patients awaiting primary total joint replacement (TJR). Finally, we studied the association between therapeutic validity of preoperative therapeutic exercise and its effectiveness in terms of postoperative functional recovery. Methods: (Quasi) randomised clinical trials on preoperative therapeutic exercise in adults awaiting TJR on postoperative recovery of functioning within three months after surgery were identified through database and reference screening. Two reviewers extracted data and assessed the risk of bias and therapeutic validity. Therapeutic validity of the interventions was assessed with a nine-itemed, expert-based rating scale (scores range from 0 to 9; score ≥6 reflecting therapeutic validity), developed in a four-round Delphi study. Effects were pooled using a random-effects model and meta-regression was used to study the influence of therapeutic validity. Results: Of the 7,492 articles retrieved, 12 studies (737 patients) were included. None of the included studies demonstrated therapeutic validity and two demonstrated low risk of bias. Therapeutic exercise was not associated with 1) observed functional recovery during the hospital stay (Standardised Mean Difference [SMD]: −1.19; 95%-confidence interval [CI], −2.46 to 0.08); 2) observed recovery within three months of surgery (SMD: −0.15; 95%-CI, −0.42 to 0.12); and 3) self-reported recovery within three months of surgery (SMD −0.07; 95%-CI, −0.35 to 0.21) compared with control participants. Meta-regression showed no statistically significant relationship between therapeutic validity and pooled-effects. Conclusion: Preoperative therapeutic exercise for TJR did not demonstrate beneficial effects on postoperative functional recovery. However, poor therapeutic validity of the therapeutic exercise programmes may have hampered potentially beneficial effects, since none of the studies met the predetermined quality criteria. Future review studies on therapeutic exercise should address therapeutic validity. (aut.ref.

Dutch guideline on total hip prosthesis

Contains fulltext : 97840.pdf (publisher's version ) (Open Access

Early and midterm results of the arterial switch operation: A 9-year, single-center experience

PubMedID: 28263145Background: The arterial switch operation (ASO) has become the surgical approach of choice for transposition of the great arteries. The aim of this paper was to describe the outcomes in patients who underwent arterial switch operation and to analyze the predictors of in-hospital mortality and further need for reoperation at a single-center institution. We reviewed our 9-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) or Taussig- Bing anomaly (TBA) to assess the early and midterm outcomes. Methods: Between January 2007 and May 2016, 34 consecutive patients who underwent ASO for TGA with IVS; and TGA with ventricular septal defect (VSD); and double outlet right ventricle (DORV) with subpulmonary VSD at our institution were included in this retrospective study. The same surgeons operated on all patients. Patients' charts, surgical reports, and echocardiograms were retrospectively reviewed. Median follow-up time ranged from 1 to 9 years, 54.2 (0.4- 108) months. Results: There were 2 (5%) in-hospital deaths. Late death occurred in 1 (2.9%) of 32 survivors. One patient (2.9%) required reintervention. The freedom from reintervention rate was 95.9 ± 1.8% at 9 years. Two patients (3.9%) developed moderate neoaortic regurgitation during the follow-up and one patient underwent reoperation mainly for neopulmonary artery stenosis. The analysis showed that weight, crossclamp (CC) time, cardiopulmonary bypass (CPB) time, and age of operation are strong predictors for mortality. Conclusion: ASO remains the procedure of choice for the treatment of various forms of TGA with acceptable early and midterm outcome, and can also be performed with a low risk of early mortality and satisfactory midterm outcomes even in a small-volume center. Early and midterm survival is excellent after arterial switch operation. © 2017 Forum Multimedia Publishing, LLC

Repair of congenital heart defects by using the minimal right vertical infra-axillary thoracotomy in children under one year of age

Background: The minimal right vertical infra-axillary thoracotomy approach is one type of incision procedure for congenital heart operations. Objectives: This report describes our experience with this exposure in a limited group of patients under one year of age. Methods: We retrospectively reviewed 44 patients that underwent correction of a congenital heart defect utilizing a standard median sternotomy or a minimal right vertical infra-axillary thoracotomy over one year period. Group 1 consisted of 12 patients that underwent the minimal right vertical infraaxillary thoracotomy while group 2 was made up of 32 patient’s underling a standard median sternotomy. Variable utilized in this comparison included; length of incision, total operative time, cardiopulmonary bypass and cross clamp time, total chest tube output, length of ICU and hospital stay, and duration of mechanical ventilator support. Results: During follow-up period, no deaths were observed in both groups. Both groups had no reoperation for bleeding or residual shunt and had no morbidity. Group 1 patients’ families were very satisfied. Group 1 had a statistically longer bypass time, then Group 2 (P = 0.031). Group 1 had less chest tube drainage (P = 0.069), shorter ventilator times (P = 0.03) and shorter ICU (P = 0.022) and hospital stays (P = 0.03) then compared to Group 2. Conclusions: The intracardiac repair of certain congenital heart defects in children under one year of age can be performed safely and effectively using the right vertical infra-axillary minithoracotomy approach. © 2016, E-Century Publishing Corporation. All rights reserved

Sternoclavicular joint dislocation with innominate artery injury

A 23-year-old man developed a incomplete injury of the innominate artery 15 days after blunt chest trauma. Sternoclavicular joint dislocation was caused injury of innominate artery. The patient had superior caval syndrome symptoms. We thought aort or arch's injured. The patient was managed with urgent surgical procedure and applied median sternotomy with femoro-femoral cardiopulmonary bypass. The patient was discharged without any problem

Left atrial extension of hepatoblastoma via left superior pulmonary vein

PubMedID: 24229501Hepatoblastoma is the most common malignant liver tumour in early childhood. The metastatic extension of hepatoblastoma into the left atrium via the pulmonary vein is rare. Reported lesions almost always involve a right-sided approach. Here we report the case of a 3-year-old girl with a recurrent hepatoblastoma at multiple sites, including the left atrium, brain, and lung. The patient was treated surgically for the prevention of further embolic complications and cardiac failure. © Cambridge University Press, 2013

A Case of Neonatal Heart Failure Caused by Left Ventricular Diverticulum: Successful ECMO Support Application

PubMedID: 27585200Congenital left ventricular diverticulum is a rare cardiac anomaly. During the newborn period, symptomatic patients are diagnosed with heart failure findings. We present a 23-day-old male newborn with congenital left ventricular diverticulum diagnosed during fetal echocardiographic examination. After the birth, the patient had heart failure symptoms and his echocardiographic examination showed low cardiac ejection fraction. Diverticulum was operated with endoventricular circular patch plasty (DOR) technique, and after, cardiopulmonary bypass venoarterial extracorporeal membrane oxygenation (ECMO) support was performed because of low cardiac output syndrome. On postoperative day 17, he was discharged with no problem

Prenatal diagnosis of giant left ventricular diverticulum: Case report

PubMedID: 25286772The distinction between a ventricular aneurysm and diverticulum is difficult. The differences between these two are based on anatomical, histological, and functional criteria. We present a case of prenatal diagnosis of a giant left ventricular outpouching at 28 weeks gestation. During the postnatal period, the neonate underwent surgical correction for the outpouching. Histopathological examination reported the resected segment was a cardiac diverticulum. Our case indicates that differentiating between the two diagnoses during the intrauterine period is not always straightforward and possible. Histopathological examinations are sometimes necessary to make a precise differentiation. Treatment should be individualized depending on the clinical presentation. Mini-Abstract The distinction between a ventricular aneurysm and diverticulum is difficult. The differences between these two are based on anatomical, histological, and functional criteria. We present a case of prenatal diagnosis of a giant left ventricular outpouching at 28 weeks gestation. During the postnatal period, the neonate underwent surgical correction for the outpouching. Histopathological examination reported the resected segment was a cardiac diverticulum. Our case indicates that differentiating between the two diagnoses during the intrauterine period is not always straightforward and possible. Histopathological examinations are sometimes necessary to make a precise differentiation. Treatment should be individualized depending on the clinical presentation. © 2014, Wiley Periodicals, Inc

Bilateral popliteal entrapment syndrome associated with plantar flexion of a phenomenon

Popliteal artery entrapment syndrome (PAES) presents with intermittent claudication; however, in the later stages, acute ischemia can occur as a result of complete arterial occlusion or embolism. We present a patient that symptomatic with plantar flexion. PAES was diagnosed with magnetic resonance imaging (MRI) and angiography. In operation medial head of gastrocnemius was resected and popliteal artery resection end to end anastomosis technic was performed. After surgery patient discharged with no symptom and problem. Ischemic symptoms in the lower leg in young patients with extremity movement, PAES must be considered. Correct diagnosis for PAES are important for preventing deterioration in the patient's clinical condition. © 2014, EManuscript Services. All rights reserved

Analysis of early predictor effect of serum Glutathione S-Transferase P1 isoenzyme on post-operative results in paediatric cardiac surgery

Backround: Glutathione S-Transferase P1 is an important enzyme playing role in detoxification of oxidative stress products developing in the course of inflammation. Aim: The aim of this study was to detect if Glutathione S-Transferase P1 (GSTP1) isoenzyme might be an early predictor of mortality. Methods: This prospective study examined 30 paediatric patients to have had open cardiac surgery under cardiopulmonary bypass. Patients were divided into two groups; those discharged without any problem (Group 1, N=23) and exitus (Group 2, N=7). Blood samples were collected at five times of (i) after anesthesia induction (T1), (ii) 10 minutes after cardiopulmonary bypass started (T2), (iii) 10 minutes after cross clamp was placed (T3), (iv) at the 30thminute following cardiopulmonary bypass (T4) and (v) at the 8thhour following the operation (T5). Results: Group 1 patients had been discharged from hospital and 7 of them died (Group 2). In T1, a statistically significant difference (two folds) was detected between the two groups in terms of GSTP1 values. Although GSTP1 values of both groups decreased during cardiopulmanary bypass period (T2, T3), a statistically significant difference was found between the two groups (p=0.001). GSTP1 values of the study groups in T4 and T5 were measured to be higher than the values recorded in T1, T2 and T3 (P0.001). GSTP1 values of the Group 2 were also detected to increase by two folds in T4. Comparison of creatinine values produced no statistically significant difference between the two groups in the period from T1 to T4. Mean creatinin level of Group 2 was observed to considerably increase in T5 and a statistically significant difference was observed between the creatining levels of the two groups (P0.001). Conclusion: GSTP1 isoenzyme may be used as an early prognostic marker following a pediatric cardiac surgery with CPB. © 2016, E-Century Publishing Corporation. All rights reserved