Native Joint Infections by Aspergillus Species

Background: Septic arthritis due to Aspergillus spp. represents a rare, but severe disease. Nevertheless, clear guidelines regarding most effective medical treatment have not yet been established. The present study is a literature review of all reported cases of fungal septic arthritis due to Aspergillus spp, in order to clarify epidemiology, as well as the medical and operative management and their outcome. Methods: A meticulous review of all published septic arthritis infections due to Aspergillus has been conducted. Information regarding demographics, causative fungus, antifungal treatment (AFT), surgical intervention, as well as the infection’s outcome were recorded and evaluated. Results: A total of 30 Aspergillus spp. strains from 29 hosts have been studied. The patients’ mean age was 45.8 years. The most commonly affected joint was the knee (45.7%), while the predominant symptom was joint pain (62%). Most patients were immunocompromised (72.4%). Diagnosis was established through cultures and/or histopathology. Aspergillus fumigatus was the most common responsible fungi (63.3%), followed by A. flavus (16.6%) and A. terreus (10%). Regarding AFT, the preferred agent proved to be Amphotericin B (14 cases; 48.3%), followed by voriconazole (11; 37.9%), while the mean AFT duration was 5.6 months. In most cases surgical treatment was also performed (in 4 cases no surgery was reported). Treatment was effective in 20 cases (69%). Conclusions: Septic arthritis caused by Aspergillus spp. represents a severe clinical entity. It seems that, with the available data, prolonged AFT along with surgical intervention is the preferred management of this infection, while identification of the responsible fungus is of utmost importance

Pitfalls with the MAKO Robotic-Arm-Assisted Total Knee Arthroplasty

Robotic-arm-assisted total knee arthroplasty (RATKA) with the MAKO system minimizes deviations in implant alignment and yields superior precision in implant position compared to a manual total knee arthroplasty. In this comprehensive commentary, we present and categorize the limitations and pitfalls of the procedure and we also provide recommendations for avoiding each limitation. The main surgeon-related limitations include prolonged operation duration, loose insertion of the checkpoints and pins, wrong registration and mapping, and damage to soft tissues during bone cutting. The system-related issues include the interruptions of the saw-cutting due to vibrations, specifications for the operating room floor and power supply, the high cost of the system, as well as the cost of each operation due to the extra implants, inability to use the system with various prostheses, wireless connection interruptions between the system’s components, and hardware issues with the six joints of the robotic device. In order to circumvent the potential challenges in this surgical procedure, it is essential to possess sufficient experience and undergo comprehensive training. Maintaining continuous awareness of the additional implants throughout the entire operation and prioritizing the preservation of soft tissues are of paramount significance. A profound comprehension of the system and its inherent constraints can also prove to be pivotal in certain situations

Σύνδρομο κοιλιακών προσαγωγών μυών σε αθλητές: χειρουργική προσέγγιση και αντιμετώπιση

Το σύνδρομο κοιλιακών προσαγωγών (αθλητική ηβαλγία) αντιπροσωπεύει έναν αθλητικό τραυματισμό, που παρουσιάζεται κυρίως με πόνο στη βουβωνική χώρα, που συχνά διαγιγνώσκεται λανθασμένα ή υπο- διαγιγνώσκεται. Οι αθλητές που εκτελούν ταχεία επιτάχυνση, κινήσεις επιβράδυνσης και επαναλαμβανόμενες στροφές υψηλής ταχύτητας, καθώς και ανοίγματα είναι ιδιαίτερα ευάλωτοι σε αυτόν τον τραυματισμό. Το σύνδρομο κοιλιακών προσαγωγών ορίζεται κυρίως ως πόνος στη βουβωνική χώρα σε ασθενείς που εμπλέκονται ενεργά σε αθλητικές δραστηριότητες, αν και μπορεί επίσης να συμβεί και σε μη αθλητές. Η θεραπεία θα πρέπει να εξατομικεύεται με βάση το επίπεδο του αθλητή, το χρονικό διάστημα πριν από την επιστροφή του αθλητή στο άθλημα και το χρονοδιάγραμμα της αθλητικής περιόδου. Είναι, ως εκ τούτου, υψίστης σημασίας για τους αθλητές υψηλών απαιτήσεων να υποβληθούν σε μια διαδικασία που έχει χαμηλά ποσοστά υποτροπής, γρήγορο χρόνο αποκατάστασης και ταχεία επιστροφή στις αθλητικές τους δραστηριότητες. Σκοπός της μελέτης αυτής ήταν η αναφορά των αποτελεσμάτων, των διεγχειρητικών ευρημάτων και των επιπλοκών της ενδοσκοπικής χειρουργικής θεραπείας σε αθλητές υψηλού επιπέδου που πάσχουν από σύνδρομο κοιλιακών προσαγωγών (αθλητική ηβαλγία) σε μια περίοδο μεγαλύτερη των 15 ετών. Η παρούσα μελέτη περιέχει ένα αναδρομικό και ένα προοπτικό κομμάτι. Αποτελεί στο σύνολό της μελέτη παρατήρησης. Όλοι οι ασθενείς που υποβλήθηκαν σε επεμβατική θεραπεία με λαπαροσκοπική τεχνική ολικής εξωπεριτοναϊκής [Total extraperitoneal (TEP)] τοποθέτησης πλέγματος, λόγω συνδρόμου κοιλιακών προσαγωγών μυών (αθλητική ηβαλγία) στο τμήμα Γενικής, Λαπαροσκοπικής, Ογκολογικής και Ρομποτικής Χειρουργικής του Ιατρικού Κέντρου Αθηνών συμπεριλήφθηκαν στην μελέτη. Συνολικά 130 ασθενείς (115, 88,5% άνδρες και 15, 11,5% γυναίκες) καταγράφηκαν ως επαγγελματίες αθλητές. Διεγχειρητικά, συνολικά 26 (21,5%) ασθενείς είχαν συνυπάρχουσα αληθή βουβωνοκήλη. Σε μέση παρακολούθηση 76.6 μηνών δεν καταγράφηκε καμία υποτροπή. Η λαπαροσκοπική θεραπεία, με τοποθέτηση πλέγματος, σε αθλητές που υποφέρουν από αθλητική ηβαλγία, ακολουθούμενη από ένα πρόγραμμα αποκατάστασης 3 εβδομάδων, φαίνεται να προσφέρει ταχεία ανάκαμψη, ταχεία επιστροφή στον αθλητισμό, καθώς και πολύ χαμηλό ποσοστό επιπλοκών και καμία υποτροπή.Athletic pubalgia is an obscure sport injury, presenting mainly with groin pain during twisting movements. The present 15-year study evaluates outcomes, intraoperative findings and complications of the endoscopic surgical treatment in competitive athletes. All competitive athletes, from 2004 to 2018, suffering from athletic pubalgia, treated with laparoscopic Total Extra-Peritoneal technique, at the Department of General, Laparoscopic, Oncologic and Robotic Surgery of the Athens Medical Center were included in this retrospective cohort. Postoperative pain, complications, return to previous training routine and patients’ satisfaction were evaluated. A total of 130 patients (115; 88.5% males and 15; 11.5% females) with 26.7 [standard deviation (SD): 7.5] mean age were evaluated. Preoperatively, mean numeric scale pain was found to be 7.7 (SD= 1.7). Three days postoperatively, the mean numeric pain scale was 3.4 (SD= 1.5), showing 55.8% decrease. The mean time for return to sports activity was found to be 6.27 weeks (SD=3.02). Regarding complications, six patients (4.6%) had slight numbness at the groin area during the first 6 postoperative months and one patient (0.8%) suffered from a postoperative hematoma. No recurrence was observed. At the final follow-up [mean=76.58 months (SD=46.5)], a total of 97 (74.7%) patients were very satisfied, 31 (23.8%) satisfied and 2 (1.5%) not satisfied with the outcome. Although athletic pubalgia’s pathophysiology remains unclear, the reported outcomes of endoscopic operative treatment in the present study in competitive athletes add significant evidence towards the standardization of endoscopic surgical techniques in the management of this clinical entity

Surgical treatment of athletic pubalgia

Athletic pubalgia is an obscure sport injury, presenting mainly with groin pain during twisting movements. The present 15-year study evaluates outcomes, intraoperative findings and complications of the endoscopic surgical treatment in competitive athletes. All competitive athletes, from 2004 to 2018, suffering from athletic pubalgia, treated with laparoscopic Total Extra-Peritoneal technique, at the Department of General, Laparoscopic, Oncologic and Robotic Surgery of the Athens Medical Center were included in this retrospective cohort. Postoperative pain, complications, return to previous training routine and patients’ satisfaction were evaluated. A total of 130 patients (115; 88.5% males and 15; 11.5% females) with 26.7 [standard deviation (SD): 7.5] mean age were evaluated. Preoperatively, mean numeric scale pain was found to be 7.7 (SD= 1.7). Three days postoperatively, the mean numeric pain scale was 3.4 (SD= 1.5), showing 55.8% decrease. The mean time for return to sports activity was found to be 6.27 weeks (SD=3.02). Regarding complications, six patients (4.6%) had slight numbness at the groin area during the first 6 postoperative months and one patient (0.8%) suffered from a postoperative hematoma. No recurrence was observed. At the final follow-up [mean=76.58 months (SD=46.5)], a total of 97 (74.7%) patients were very satisfied, 31 (23.8%) satisfied and 2 (1.5%) not satisfied with the outcome. Although athletic pubalgia’s pathophysiology remains unclear, the reported outcomes of endoscopic operative treatment in the present study in competitive athletes add significant evidence towards the standardization of endoscopic surgical techniques in the management of this clinical entity.Το σύνδρομο κοιλιακών προσαγωγών (αθλητική ηβαλγία) αντιπροσωπεύει έναν αθλητικό τραυματισμό, που παρουσιάζεται κυρίως με πόνο στη βουβωνική χώρα, που συχνά διαγιγνώσκεται λανθασμένα ή υπο- διαγιγνώσκεται. Οι αθλητές που εκτελούν ταχεία επιτάχυνση, κινήσεις επιβράδυνσης και επαναλαμβανόμενες στροφές υψηλής ταχύτητας, καθώς και ανοίγματα είναι ιδιαίτερα ευάλωτοι σε αυτόν τον τραυματισμό. Το σύνδρομο κοιλιακών προσαγωγών ορίζεται κυρίως ως πόνος στη βουβωνική χώρα σε ασθενείς που εμπλέκονται ενεργά σε αθλητικές δραστηριότητες, αν και μπορεί επίσης να συμβεί και σε μη αθλητές. Η θεραπεία θα πρέπει να εξατομικεύεται με βάση το επίπεδο του αθλητή, το χρονικό διάστημα πριν από την επιστροφή του αθλητή στο άθλημα και το χρονοδιάγραμμα της αθλητικής περιόδου. Είναι, ως εκ τούτου, υψίστης σημασίας για τους αθλητές υψηλών απαιτήσεων να υποβληθούν σε μια διαδικασία που έχει χαμηλά ποσοστά υποτροπής, γρήγορο χρόνο αποκατάστασης και ταχεία επιστροφή στις αθλητικές τους δραστηριότητες. Σκοπός της μελέτης αυτής ήταν η αναφορά των αποτελεσμάτων, των διεγχειρητικών ευρημάτων και των επιπλοκών της ενδοσκοπικής χειρουργικής θεραπείας σε αθλητές υψηλού επιπέδου που πάσχουν από σύνδρομο κοιλιακών προσαγωγών (αθλητική ηβαλγία) σε μια περίοδο μεγαλύτερη των 15 ετών. Η παρούσα μελέτη περιέχει ένα αναδρομικό και ένα προοπτικό κομμάτι. Αποτελεί στο σύνολό της μελέτη παρατήρησης. Όλοι οι ασθενείς που υποβλήθηκαν σε επεμβατική θεραπεία με λαπαροσκοπική τεχνική ολικής εξωπεριτοναϊκής [Total extraperitoneal (TEP)] τοποθέτησης πλέγματος, λόγω συνδρόμου κοιλιακών προσαγωγών μυών (αθλητική ηβαλγία) στο τμήμα Γενικής, Λαπαροσκοπικής, Ογκολογικής και Ρομποτικής Χειρουργικής του Ιατρικού Κέντρου Αθηνών συμπεριλήφθηκαν στην μελέτη. Συνολικά 130 ασθενείς (115, 88,5% άνδρες και 15, 11,5% γυναίκες) καταγράφηκαν ως επαγγελματίες αθλητές. Διεγχειρητικά, συνολικά 26 (21,5%) ασθενείς είχαν συνυπάρχουσα αληθή βουβωνοκήλη. Σε μέση παρακολούθηση 76.6 μηνών δεν καταγράφηκε καμία υποτροπή. Η λαπαροσκοπική θεραπεία, με τοποθέτηση πλέγματος, σε αθλητές που υποφέρουν από αθλητική ηβαλγία, ακολουθούμενη από ένα πρόγραμμα αποκατάστασης 3 εβδομάδων, φαίνεται να προσφέρει ταχεία ανάκαμψη, ταχεία επιστροφή στον αθλητισμό, καθώς και πολύ χαμηλό ποσοστό επιπλοκών και καμία υποτροπή

Trauma management in Homer's Iliad

Homer's Iliad is one of the highest intellectual products of the early ancient Greek civilisation. A plethora of medical information lies within Iliad's 24 rhapsodies, and a total of 147 injuries are described. The present study records and evaluates all cases of trauma management included in this epic poem. Not only Iliad's original text but also all myths related to Iliad from the five-volume Greek Mythology by Ioannis Kakridis were meticulously studied to locate the injured person, the type of trauma, the care provider and the type of given care as well as the outcome of each case. A total of 21 cases were found and evaluated with a 5% mortality rate. The majority of these injuries were caused by an arrow (43%) and were located to the upper extremity (43%). Injuries of the head, neck and trunk were not treated as all of them were lethal. Many of the recorded trauma management techniques can be correlated to modern medicine. Furthermore, the role and skills of military doctors and paramedics, mentioned by Homer, is discussed

Expanding Robotic Arm-Assisted Knee Surgery: The First Attempt to Use the System for Knee Revision Arthroplasty

Robotic arm-assisted arthroplasty was introduced in 2006 and has expanded its applications into unicompartmental knee, total knee, and total hip replacement. The first case of a revision surgery from conventional unicompartmental to total knee arthroplasty with the utilization of the robotic arm-assisted MAKO system is presented. An 87-year-old female presented with deteriorating left knee pain due to failure of medial unicompartmental knee arthroplasty at the outpatient clinic. The patient was advised to undergo revision surgery. Through medial parapatellar arthrotomy, the joint was exposed. With the use of the MAKO system, the estimated depth of the medial plateau according to CT planning was found to be 10 mm more distal than the lateral. The resection line of the remaining plateau was placed deliberately 2 mm more distal in order to achieve satisfactory replacement of the bony gap of the medial tibial condyle by a 10 mm augment. The patient had an uneventful recovery. A plethora of additional applications in the future, such as total shoulder or reverse total shoulder arthroplasty, megaprosthesis placement in oncological patients, and total hip or knee revision surgeries, may improve patient-related outcomes

The effect of scoliosis surgery on pulmonary function in spinal muscular atrophy patients: review of the literature and a meta-analysis.

PURPOSE To determine the effect of surgical instrumentation on pulmonary function after surgery. METHODS A literature review was performed to identify articles reporting on the effect of scoliosis surgery on the pulmonary function in patients with spinal muscular atrophy (SMA). Data for each patient were extracted from included studies, and a meta-analysis was performed using the values of forced vital capacity (FVC) before and after surgery. RESULTS A total of 127 articles were reviewed, and ten articles were selected for data extraction according to inclusion criteria. The results of the meta-analysis showed no difference in respiratory function pre-operatively and at last follow-up. Four out of ten studies demonstrated similar results and five studies reported a decrease in pulmonary function after surgery. Only one study showed improvement in lung function. CONCLUSION At the moment, there is insufficient evidence in the literature to support that spinal surgery can improve respiratory function. According to our meta-analysis study, vital capacity remains either unchanged or the rate of deterioration is decreased after surgery. Nevertheless, these are both considered favorable outcomes taking into account the natural course of the disease with progressive deterioration of pulmonary function over time

Combined open bipolar Monteggia and Galeazzi fracture: a case report with a 1-year follow-up

Monteggia and Galeazzi fractures account for 1-5% of total forearm fractures. A combined Monteggia and Galeazzi fracture is an extremely rare injury. We present a case of a Gustillo-Henderson type 2 open combined bipolar Monteggia and Galeazzi fracture, as well as fracture of the ulnar coronoid process in a 49-year old male. The patient was treated surgically, with open reduction and internal fixation. At 6 months postoperative, he was diagnosed with pseudarthrosis and underwent surgery with autologous bone grafting from the iliac crest. At the 1-year follow-up, the patient presented an extension deficit of 5 degrees in elbow, a 15 degrees deficit in pronation and 20 degrees deficit in supination of the wrist. The patient continues to work as a painter without significant problems in his everyday routine and he is still regularly engaged in cycling. Additionally we provide a historical background of these injuries

Surgery for spinal metastatic tumors: Prognostication systems in clinical practice (Review)

The management of spinal metastatic tumors is a matter of increasing clinical importance, as 20-40% of cancer patients have evidence of vertebral metastatic disease at the time of their passing and up to 20% develop neurological symptoms due to epidural spinal cord compression. The treatment of patients with spinal metastases is challenging, albeit palliative, and it requires a multidisciplinary approach. Accurate prediction of life expectancy of patients with cancer is of paramount importance for therapeutic strategy. Prognostication scoring systems were developed to aid clinicians to follow a more objective, safe and evidence-based approach with therapy selection and surgical intervention indications. In this context, the aim of the present review was to briefly discuss the evolution of scoring systems since their introduction in the early 90s until today, their advantages and shortcomings, and the future requirements for personalized scoring in the era of modern oncology

Outpatient Clinic in Ancient Greece.

Introduction: Several sciences, including medicine, have their origin in Ancient Greece. It is intriguing to comprehend how Ancient Greek physicians were practicing medicine. The present study evaluates the role of an Ancient Greek physician in an outpatient clinic by examining the first depiction of such a clinic in Western history which is painted on the surface of a red-figured rounded small vase (aryvallos). Methods:An Ancient Greek aryvallos painted c. 480-450 BC, now on display at the Louvre museum, was meticulously studied regarding its painted surface, which presents an outpatient clinic in Ancient Greece. Other Ancient Greek works of art presenting medical activities have been also evaluated in order to reach informed conclusions regarding medical practice of that period. Results:The aryvallos depicts a physician performing bloodletting in a patient. Another five males, four of them with traumas holding canes are waiting their turn. Among them, a dwarf holding a hare on his shoulder can be seen. Suction cups on the wall and a copper basin on the floor for blood collection are also included in the picture. Discussion and conclusion: The aryvallos depicts the earliest known realistic scene of medical service in Western history. All previous Ancient Greek scenes which dealt with relevant themes, invariably included "holy" and divine interventions. Trauma management, as well as bloodletting seem to form part of the everyday medical practice of that time, while gifts to physicians (one of possible explanations of the dwarf's hare, which is depicted on the aryvallos scene) were common. Additionally, historical sources reveal that Ancient Greek physicians were well-paid and much respected. Medicine has always been an honorable practice throughout the centuries