Ultrasound-Guided Unilateral Posterior TAP Block for Lower Abdominal Surgery in Children

Objectives: This study aimed to evaluate the analgesic effect of ultrasound-guided transversus abdominis plane block in children. Methods: Children between 3-18 years of age on whom lower abdominal surgeries were preformed are included in this random control trial (RCT). The parents signed a written consent form. Patients were randomized into control and study groups. Every group was divided into subgroups either with or without inflammation. Results: There were no differences between the two studied groups regarding demographic and clinical characteristics. Hemodynamics were more stable in the study group than in the control group. After induction, BP decreased in all groups and increased after surgical incision except for the transversus abdominis plane elective (TAP + Elec) group. An elevated white blood cell count was used as the mean indicator of inflammation. The opioid usage during the operation was significantly different in the subgroups (p = 0.000). The relationship between WBC and opioid usage was weak, positive, and statistically significant. Postoperative pain and pain medication requirements were lower in the TAP block group. Conclusion: Transversus abdominis plane block under ultrasound guidance is easy, safe, reliable, and adequate for analgesia in children. This method can decrease surgical and postoperative pain and analgesic requirements

The Results of the Total Hip Arthroplasty Using 3D Printing Technology

Objectives: To study the value of 3D printing of custom THA femoral prostheses with conventional femoral prostheses in total hip arthroplasty for severe hip deformity. Methods: Total hip arthroplasty was used in the treatment of 107 severe hip joint deformity cases from June 2018 to June 2019. Fifty-six patients received conventional hip replacement stems and 51 patients received a custom 3D printed hip replacement stem designed to address their proximal deformity and leg length discrepancy. The operation time, intraoperative blood loss, postoperative weight-bearing time, Harris score before and after the operation, complications after surgery and the main angle measurement of compared to their contralateral hip were evaluated to determine the short-term efficacy of 3D printed total hip replacement femoral prosthesis compared to the common total hip replacement femoral prosthesis. Results: A total of 107 patients were followed up for an average of 12 months. The use of 3D printing technology in the preoperative design and custom prosthesis fabrication was associated with shortened operation time, less intraoperative blood loss, quicker time to postoperative full weight-bearing, and improved the Harris score in 1 year after the operation compared to conventional total hip replacement stem (p<.05). Our results revealed that there was a significant reduction in the femoral anteversion with a value of 13.06 ± 1.93 degrees (mean ± SD) in the custom prosthesis group compared to the conventional hip replacement group. However, there was no significant difference in neck-shaft angle, acetabular angle, and Sharp angle between both groups (p>.05). Conclusion: 3D printing technology created a virtual and realistic simulation, and personalized operation plan for patients with severe hip deformity, which was helpful for surgical treatment. The anatomical characteristics of patients with complex deformities were better addressed using the 3D printed femoral component and resulting in better patient outcomes and provided a new option for surgeons to manage these difficult cases

Mid-Term Results of High Tibial Osteotomy Regarding From Grades of Knee Osteoarthritis

Objectives: The number of high tibial osteotomy (HTO) has significantly increased in Mongolia, however, researchers are still debating about the impact of severity of knee osteoarthritis on the outcome of high tibial osteotomy. The purpose of our study is to report the mid-term results of HTO for knee osteoarthritis according to the Kellgren Lawrence classification. Methods: A total of 100 patients who underwent high tibial osteotomy for knee osteoarthritis from October 2019 to June 2020 at the Joint Center of the First Central Hospital of Mongolia participated in this study. Outcome evaluation of the participants was accomplished at baseline, at 2 months, 6 months, 8 months and 18 months post-operatively. Results: Lateral closing wedge HTO was performed in 54.2 % of patients who had 1st grade deformity and 55.9 % of patients who had 2nd grade deformity. On the other hand, medial opening wedge HTO was performed in 3rd grade patients compared to other grades. WBL was 11.43 ± 8.22 at preoperative, and increased to 56.31 ± 4.52 after 12 months of the surgery in 3rd grade. The total WBL was improved from 20.54 ± 12.57 to 57.24 ± 3.69 after two months of surgery and 57.89 ± 4.17 after 12 months. Conclusion: Our study showed that the severity of knee osteoarthritis had impact on outcome of high tibial osteotomy

The Position and Stability of the Prosthesis in Severely Deformed DDH Artificial Total Hip Replacement

Objectives: To analyze the correlation of prosthesis position selection during total hip replacement with clinical short and middle-term effects of Crowe III and Crowe IV hip dislocation. Methods: Clinical data of 28 cases of dysplasia and dislocation of the hip joint combined with severe osteoarthritis were retrospectively analyzed. During 2-year follow-up, patients were rechecked by imaging regularly to analyze the imaging changes of acetabulum prosthesis position and bone graft fusion. Harris hip score was used to assess the recovery of hip function. The correlation of prosthesis position and short and middle-term effects was analyzed. Results: The filling rate of medullary cavity of prosthesis was above 75%. The initial position was fixed and stable. The stability rate of femur-prosthesis interface reached 100%. Compared with pre-replacement, hip function was significantly improved at 6 months post surgery (p < 0.05). Conclusion: These results indicate that total hip replacement for Crowe III and Crowe IV hip dislocation can effectively reconstruct the acetabulum, recover hip function, and stabilize prosthesis. Total hip replacement is characterized by good filling rate, high stability of femoral prosthesis interface, and stable initial fixation. The clinical repair effect is strongly associated with the position of the prosthesis

Ilioinguinal and Iliohypogastric Nerve Blocks in Children

Objectives: To examine ilioinguinal and iliohypogastric (ILIH) nerve block techniques among children. Methods: A total of 120 children, aged 1-16 years, were included in this prospective, randomized, single-blinded study. Children received an ILIH nerve block using the conventional fascial click of double “pop” technique on four different points: (Group I, n=30) ILIH block at the junction of the lateral one-fourth, the medial three-fourth in the line from the anterior superior iliac spine (ASIS) to the umbilicus; (Group II, n=28) approximately 2.5 mm medial to the ASIS; (Group III, n=30) 10 mm medial-superior to the ASIS; and (Group IV, n=30) 10mm medial-inferior to the ASIS. Intraoperative hemodynamic changes, postoperative pain intensity, time of first analgesic requirement, and correlation between BMI and groups were examined. Results: The average pain score 2 hours after operation was lowest in group I (1.04±1.23 [Cl 95%, 0-5.3]) and highest in group IV (2.88±2.47 [Cl 95%, 0-9]), a difference of statistically significance (p=0.0027). In group I only, the pain intensity had a weak, positive correlation with BMI (r=0.49, p=0.006). Conclusion: Group I used the best ILIH block technique

Efficacy and Safety of Radiofrequency Ablation for Benign Thyroid Nodules: Initial Mongolian Experience

Objectives: To assess the efficacy and safety of thyroid radiofrequency (RF) ablation for benign thyroid nodules for a 24 months period. Methods: From 2019 to 2021, 485 nodules were from 183 patients (mean age 47.7 ± 11.2) who met eligibility criteria were enrolled from participants. At pre-ablation, the median volume was 0.371 mL (CI 95 %; 0.289 - 0.513). For 1, 3, 6, 12 and 24 months after treatment, 485 lesions, consisting of 258 (27 %) solid, 108 (11.3 %) predominantly solid, 47 (4.9 %) cystic, 25 (2.6 %) predominantly cystic and 47 (4.9 %) sponge were followed. RFA treatment was performed using two standard techniques (trans isthmic and moving-shot) and an RFA V-1000 cooling system. For 24 months, nodule size reduction was assessed. Results: At pre-ablation, the median volume was 0.371 mL (CI 95 % 0.289 - 0.513). For 1, 3, 6, 12 and 24 months after treatment, median volume reduction was 0.263 (CI 95 %; 0.205 - 0.325 p < 0.000), 0.163 (CI 95 %; 0.124 - 0.218 p < 0.000), 0.153 (CI 95 %; 0.074 - 0.194 p < 0.000), 0.148 (CI 95 %; 0.046 - 0.150 p < 0.000), and 0.062 (CI 95 %; 0.006 - 0.111 p < 0.000) respectively. Median volume statistically decreased significantly p = 0.000. Both mean symptom and cosmetic scores showed significant improvements (p < 0.001). All complications were also evaluated during the follow-up. Conclusion: Thyroid RF ablation is an effective and safe treatment modality in patients with benign thyroid nodules. RF ablation may be as effective as surgery if it is performed by experienced physicians in optimally selected patients

Acoustic Outcomes Comparison Injection Versus Medialization Laryngoplasty

Objectives: To determine whether injection laryngoplasty or medialization thyroplasty is more effective in the treatment of unilateral vocal fold paralysis. Methods: A prospective study of 75 patients with unilateral vocal cord paralysis who underwent autologous fat injection laryngoplasty or medialization laryngoplasty at the First Central Hospital of Mongolia between 15th Nov 2016 and 15th Jan 2020. The data analyzed included patient characteristics and type of intervention, along with the before treatment, 1 and 6 months after treatment voice parameters of electrogIottography and patients\u27 subjective voice assessment. Results: Seventy-five patients were evaluated. The average time from intervention to post-treatment evaluation was 1 and 6 months. Improvements were demonstrated in all voice parameters (Maximum Foniation Time, Jitter, Shimmer, and Harmonic Noise Ratio) in both the injection and the medialization groups. Conclusions: In this study, objective and subjective voice analysis confirmed that injection and medialization laryngoplasty were effective in unilateral vocal cord paralysis. Both of these methods can be used to treat unilateral vocal cord paralysis

Efficacy and Safety of Radiofrequency Ablation Versus Surgery for Thyroid Nodules

Objectives: To assess the efficacy and safety of radiofrequency (RF) ablation versus surgery for benign thyroid nodules for 24 months period. Methods: From January 2019 to January 2021, 200 patients with nodular goiters who underwent surgery (group A) and 183 patients treated by radiofrequency ablation (group B) were enrolled in this study. Inclusion criteria were the following: 1) cosmetic problem, 2) nodule-related symptoms, 3) refusal of surgery (for group B). An internally cooled radiofrequency ablation system and an 18 g internally cooled electrode were used. We compared the 2 groups in terms of efficacy, and safety during a 2-year follow-up. Results: Nodule type did not differ between groups, although in total 60.1 % were solid, 31.3 % were mixed, and 8.6 % were cystic. However, the number of nodules, median volume before surgery, and diameter of the nodule differed significantly. The median volume reduction was 34.6 % at 1 month, 56.1 % at 3 months, 70.6 % at 6 months, 73.9 % at 12 months, and 74.9 % at 24 months. Any volume reduction between follow-up intervals was statistically significant (p < 0.000). The most patients had no complications. However, surgical patients were more likely to have complications such as bleeding, hoarseness, and infection (14.5 %) than the RFA group (1.6 %). Conclusion: Surgical resection and radiofrequency ablation are both effective treatments of nodular goiter. Compared with surgery, the advantages of radiofrequency ablation include fewer complications, preservation of thyroid function, and fewer hospitalization days. Therefore, radiofrequency ablation should be considered a first-line treatment for benign thyroid nodules

Early Results of High Tibial Osteotomy for Osteoarthritis in Mongolia

Objectives: The objectives of this study were to examine the reproducibility of the surgical correction and pain relief following high tibial osteotomy for osteoarthritis. Methods: Twenty-seven patients who underwent high tibial osteotomy at The First Central Hospital of Mongolia were included. Patients divided into three groups based on their osteoarthritis grade using the Kellgren Lawrence classification. The weight-bearing line and medial proximal tibial angle were used for preoperative planning to assess postoperative correction. Oxford knee scores were used to assess knee pain and function. Results: The weight-bearing line and medial proximal tibial angle measurements at both postoperative time intervals were significantly different from the preoperative values (p<.001) but were not significantly different from each other. The Oxford knee scores were 31.54±6.3 preoperatively, 34.82±4.3 at two months after the surgery and improved to 40.89±2.7 six months after the surgery. Statistically significant successive improvements in scores were observed at each time interval (p<.001). Conclusion: High tibial osteotomy can be done with rigid internal fixation and can improve function and reduce pain in Mongolian patients with early arthritis without affecting joint range of motion

Application of Leech Therapy After Replantation of Severed Distal Fingers

Objective: Prevention and treatment of venous crisis after reconstructive microsurgery is complicated and every clinician has concern about it. We present our clinical experience with blood-sucking leech therapy for replantation of severed fingers. Methods: Blood-sucking leech therapy was prescribed for venous crisis due to various causes from July 2019-2020 in 8 patients whose distal fingers were severed. Results: After clinical application, their venous congestion was relieved, all the affected fingers survived, and the curative effect was satisfactory. Conclusion: In venous crisis after the replantation of severed fingers, blood-sucking leech therapy has a significant effect which can successfully prevent finger death caused by congestion, reduce the rate of necrosis, and improve survival rate. It is worthy of applying in clinical practice