Laivelio lūžio rekonstrukcija šonkaulio autotransplantatu: klinikinis atvejis ir literatūros apžvalga

Objective. To evaluate the results of scaphoid bone proximal pole reconstruction with rib osteochondral autograft due to comminuted scaphoid fracture. Material and methods. We present a clinical case of fragmented scaphoid bone proximal pole fracture reconstruction by rib osteochondral autograft. The modified wrist function score of Green and O’Brien and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measuring scales were used for clinical evaluation before and 6 months after the reconstruction. Additio­nally, a literature review was conducted for case reports and previous literature reviews describing scaphoid bone proximal pole fracture surgical treatment. Medline (PubMed), ScienceDirect and UpToDate databases were used. Results. Conventional treatment methods for the treatment of comminuted proximal pole scaphoid bone fractures are often inappropriate due to technical issues or potential adverse outcomes. In these cases, reconstruction with rib autograft is possible. The study patient’s modified wrist function score of Green and O’Brien increased from 75 to 95 points out of 100 at 6 months postoperatively, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score decreased from 13.64 to 4.55 points. The results of this technique have been investigated in several studies (Sandow, 1998, 2001; Veitch et al., 2007). All subjects (22, 47 and 14 patients, respectively), except one, experienced improvement of wrist function – enhanced wrist movement, grip strength, reduced pain and restored wrist function to the pre-injury performance level. Conclusions. Scaphoid bone proximal pole fragmented fracture reconstruction with osteochondrial rib autograft achieves favorable recovery of wrist function and avoids complications or unfavorable functional consequences of alternative surgical procedures.Tikslas. Įvertinti laivelio proksimalinio poliaus rekonstrukcijos šonkaulio osteochondriniu autotransplantatu rezultatus, gydant skeveldrinį lūžį. Tyrimo metodai. Pateikiamas laivelio proksimalinio poliaus skeveldrinio lūžio rekonstrukcijos šonkaulio osteochondriniu autotransplantatu klinikinis atvejis. Klinikiniam paciento įvertinimui prieš operaciją ir praėjus 6 mėn. po atliktos rekonstrukcijos pasitelktas modifikuotas Greeno ir O’Brieno riešo funkcijos balas ir Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) vertinimo skalė. Taip pat, naudojantis Medline (PubMed), ScienceDirect ir UpToDate duomenų bazėmis, atlikta mokslinės literatūros apžvalga, apimanti laivelio proksimalinio poliaus lūžių chirurginio gydymo metodus ir galimybes. Rezultatai. Esant laivelio proksimalinio poliaus lūžiams, ypač skeveldrinio pobūdžio, tradiciniai gydymo metodai dėl techninių atlikimo principų ar numatomų nepalankių išeičių dažnai yra netinkami. Minėtais atvejais galima rekonstrukcija šonkaulio osteochondriniu autotransplantatu. Tirtam pacientui nustatytas modifikuotas Greeno ir O’Brieno riešo funkcijos balas, praėjus 6 mėn. po rekonstrukcinės operacijos, padidėjo nuo 75 iki 95 balų iš 100, o taikant Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) apskaičiuotas balas sumažėjo nuo 13,64 iki 4,55 balų. Minimų metodikų išeitys atskleidžiamos ir keliuose užsienio tyrimuose (Sandow, 1998, 2001; Veitch et al., 2007). Šių tyrimų duomenimis, atlikus laivelio rekonstrukciją osteochondriniu šonkaulio autotransplantatu, visų tiriamųjų (atitinkamai 22, 47 ir 14 pacientų), išskyrus vieną pacientą, judesio amplitudė ir sugriebimo jėga padidėjo, sumažėjo skausmas, tiriamieji atgavo prieš traumą buvusį darbingumą. Išvados. Atliekant laivelio proksimalinio poliaus skeveldrinio lūžio rekonstrukciją, kai kaulinio audinio defektas atkuriamas osteochondriniu šonkaulio autotransplantatu, pasiekiama palankių riešo funkcijos atkūrimo rezultatų, išvengiama alternatyvioms chirurginėms procedūroms būdingų komplikacijų ar nepalankių funkcinių padarinių

A comparison of endovenous laser ablation and conventional surgery in patients with varicose veins of the lower limbs

Introduction. Even though EVLA is increasingly popular and together with other minimally-invasive techniques is rapidly replacing surgical stripping, surgical treatment is still widely used. Our study aimed to compare the clinical outcomes and the quality of life following either endovenous laser ablation (EVLA) or conventional surgery for varicose veins of the lower limbs. Material and methods. This prospective non-randomised study included 299 patients, who were treated for symptomatic varicose veins of the lower limbs in two centres. In one, 159 patients underwent open surgery (the surgery group), while in the other, 140 patients received the EVLA (the EVLA group). The patients were invited to follow-up evaluations at six weeks, one year, and two years after the surgery. Results. Disease-specific quality of life at six weeks was significantly better in the EVLA group (median AVVQ scores — 3.2 (2.1–8) vs. 9.2 (7.1–13.8), p < 0.001). Similarly, VCSS scores at six weeks were also better in the EVLA group (median VCSS scores — 1 (0–2) vs. 4 (3–6), p < 0.001). Patients in the EVLA group experienced less postoperative pain (p < 0.001), and therefore needed fewer supplementary analgesic drugs (p = 0.007). In addition, patients in the EVLA group managed to return to work and normal activities sooner than those in the surgery group (p < 0.001). No statistically significant differences were found between groups for clinical recurrence, overall satisfaction, rate of complications and secondary procedures. Conclusions. Both treatment techniques yielded similar results in terms of efficacy, clinical recurrence rates and overall patient satisfaction. However, early postoperative results in the EVLA group were superior to those of patients in the surgery group

Percutaneous transhepatic biliary stenting with uncovered self-expandable metallic stents in patients with malignant biliary obstruction – efficacy and survival analysis

The aim of this study was to assess short- and long-term outcomes of malignant biliary obstruction (MBO) treatment by percutaneous transhepatic biliary stenting (PTBS) with uncovered selfexpandable metallic stents (SEMS), and to identify predictors of survival. Material/Methods: A nine-year, single-centre study from a prospectively collected database included 222 patients with inoperable MBO treated by PTBS with uncovered nitinol SEMS. Results: Technical and clinical success rates were 95.9% and 82.4%, respectively. The total rate of postprocedural complications was 14.4%. The mean durations of the primary and secondary stent patency were 114.7±15.1 and 146.4±21.2 days, respectively. The 30-day mortality rate was 15.3% with no procedure-related deaths. The mean estimated length of survival was 143.3±20.6 days. Independent predictors increasing the risk of death included higher than 115 μmol/L serum bilirubin 2–5 days after biliary stenting (HR 3.274, P=0.019), distal (non-hilar) obstruction of the bile ducts (HR 3.711, P=0.008), Bismuth-Corlette type IV stricture (HR 2.082, P=0.008), obstruction due to gallbladder cancer (HR 31.029, P=0.012) and only partial drainage of liver parenchyma (HR 4.158, P=0.040). Conclusions: PTBS with uncovered SEMS is an effective and safe method for palliative treatment of MBO. Serum bilirubin higher than 115 μmol/L 2–5 days after the procedure has a significant negative impact on patients’ survival. Lower survival is also determined by distal bile duct obstruction, Bismuth– Corlette type IV stricture, biliary obstruction caused by gallbladder cancer and when only partial liver drainage is applied. Background Malignant biliary obstruction (MBO) can be caused by primary tumours (most frequently cholangiocarcinomas, gallbladder cancer and pancreatic carcinomas), metastases or compression of metastatic lymph nodes [1]. At the time of diagnosis, for the majority of patient[...]