Association of Kirschner wires and shape-memory staple in four-corner arthrodesis

Background. Wrist arthrosis is a painful disease that is responsible for a reduced wrist function and upper limb dysfunction. Proposed by Watson in 1984, scaphoidectomy and four-corner arthrodesis has good results in scapho-lunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) treatment. Objectives. The purpose of this study was to analyze the results of four-corner arthrodesis using Kirschner wire and shape-memory staples. Methods. 12 patients (12 wrists) were operated by scaphoidectomy and four-corner arthrodesis according to Watson technique, using Kirschner wires fixation for capito-luno-hamato fusion and shape-memory staples for hamato-triquetral fusion. The mean age of the patients was 64.7 years, and the period of follow-up was 2.1 years. Results. The results were evaluated using preoperative data, surgery protocols and clinical postoperative data obtained at follow-up: pain, patient’s satisfaction, force, range of motion, X-ray imaging. The fusion was achieved in all cases in a mean time of 2.4 months for all involved articulations. The mean postoperative range of motion was 26.25⁰ of extension, 24.16⁰ of flexion, 16.11⁰ of radial inclination and 18.89⁰ of cubital inclination. After surgery, compared to the unaffected contralateral side, grip strength was 62.8%. Conclusions. Combination of K-wires and shape-memory staple for four-corner arthrodesis is very efficient in treating SLAC and SNAC lesions

Diabetic patients and postoperative complications in colorectal surgery

Diabetes mellitus is one of the most common comorbidities of patients undergoing surgery. Colorectal surgery is frequently associated with postoperative complications, and diabetic patients represent a population that presents a high risk of developing such complications. Understanding the interrelationships between neoplastic disease and diabetes, as well as the pathophysiological mechanisms underlying postoperative complications, are essential for effective therapeutic management. Genetic predispositions, alterations in the gut microbiota, inflammatory response, ischemic, thrombotic and infectious processes contribute significantly to the development of severe surgical complications, such as anastomotic fistulas. Postoperative ileus, characterized by gastrointestinal dysmotility, is common in diabetic patients due to neuropathic dysfunction and altered intestinal metabolism. In addition, diabetic patients are at increased risk of intestinal ischemia, requiring specific perioperative care. The strategies to avoid these complications assume an adequate surgical technique, a personalized anesthesia management, and last but not least, the best possible glycemic control. This article highlights the importance of a better understanding of the interaction between diabetes and postoperative complications, in order to obtain good results with an important impact on the patient\u27s health and well-being. This article highlights the importance of a better understanding of the interplay between diabetes and postoperative complications informs targeted interventions aimed at reducing morbidity and improving patient well-being

The use of NDYAG laser combined with pulsed light in the treatment of rosacea

Rosacea is a chronic inflammatory skin disease with a complex pathogenesis that mainly affects the central part of the face, with a global incidence of 5.46%. The present study was performed on a group of 68 patients with rosacea 1 and 2 subtypes, patients between 34-63 years old. The treatments were performed using a Cutera Xeo laser, using 2 types of probes: NdYag 1064nm for telangiectasias and LimeLight 520-1100nm for diffuse facial erythema, papules, and pustules, having an 10x30mm window. For patients with diffuse facial erythema, etc., the optimal number of sessions was between 3 and 6 with or without anesthetic cream, using energies between 14-19J / cm. The average recovery time was 5 days. Registered effects included bruises, pustules, burning sensation, transient stinging, and hypopigmentation. For patients with telangiectasia, the optimal number of sessions was two, performed at an average interval of once per month/ monthly

Revision of migrated pelvic acetabular components in THA with or without vascular involvement

Purpose. The literature describes a high rate of mortality in cases of intrapelvic acetabular component migration, which is a rare but serious complication. Our aim is to establish and propose a treatment protocol according to our results and experience. Material and Methods. We performed eight (8) total hip revisions with acetabular cup migration between 2006 and 2012. A vascular graft was needed in four (4) of these cases. Two (2) cases were revisions after a spacer for infected arthroplasties. The protocol included the following: X-Ray examination (frontal and lateral views), CT angiography, a biological evaluation, a suitable pre-operative plan, at least six (6) units of blood stock, an experienced anesthesiologist, an experienced surgical team that included a vascular surgeon and a versatile arsenal of revision prostheses, bone grafts and vascular grafts. The anterolateral approach was generally used for hip revisions and the retroperitoneal approach in the dorsal decubitus position was used when vascular risk was involved. Results: The acetabular defect was reconstructed using bone grafts and tantalum revision cups in 4 cases, Burch-Schneider cages in 2 cases, a Kerboull ring in 1 case and a cementless oblong cup (Cotyle Espace) in 1 case. In 4 cases, an iliac vessel graft procedure was conducted by the vascular surgeon. All patients survived the revision procedures and returned regularly for subsequent check-ups, during which they did not show any septic complications. Conclusions: Intrapelvic acetabular cup migration is a rare but serious complication that can occur after total hip arthroplasty in either septic or aseptic cases. An experienced, multidisciplinary team of surgeons should be involved in planning and conducting such complicated revisions