جستجوی مقالات مرتبط با کلیدواژه « Surgical Treatment » در نشریات گروه « پزشکی »

The prevalence of atypical femoral fractures in the elderly population is increasing worldwide, including in Iran. Left untreated, these fractures can lead to disability and reduced quality of life for patients.This study aims to evaluate surgical outcomes in patients with atypical femoral fractures.

This case-series study was conducted at Rasoul Akram Hospital on patients with atypical femoral fractures who underwent surgery from 2013 to 2020. Demographic and clinical information, including gender, age, fracture site, type of surgery, infection, and postoperative walking ability, as well as modified Harris Hip Score (HHS) and Numeric Rating Scale (NRS) scores, were collected at one month and one year after surgery.

Among the 30 participants in this study, 24 (80%) were female. The mean age of the patients was 68.66 ± 11.03 years. Of the patients, 46.7% underwent plate surgery, 26.7% had intramedullary nailing, and 26.7% underwent PFNA surgery. After surgery, 6 patients (20%) regained the ability to walk, 20 were able to walk with a cane or walker, and 4 could not walk. The NRS score of patients decreased by 2.80 ± 1.20 points after surgery, while the modified HHS score increased by 9.13 ± 22.56 (P value >0.05). After surgery, 13.3% of patients developed an infection. The type of surgery did not significantly affect patients' pelvic function or pain after surgery (P value> 0.05).

The rate of complications and postoperative infections in surgeries for atypical femoral fractures is higher than for typical fractures, and the postoperative mobility and satisfaction of these patients are lower than usual.

This study aimed to observe the clinical effect of modified Devine’s surgical technique in the treatment of concealed penis.

From July 2015 to September 2020, fifty-six children with concealed penis were treated with modified Devine’s technique. Recorded the penile length and the satisfaction score preoperatively and postoperatively to confirm the effect of the surgery. Followed up the penis for bleeding, infection and edema one week and four weeks after the operation. Twelve weeks after the operation, we measured the length of the penis and observed whether there was a retraction.

The length of the penis has been effectively lengthened(P < 0.001). There was significant improvement in parents’ satisfaction grades (P < 0.001). All the patients had different degrees of penile edema after the operation. Most of the penile edema subsided about four weeks after the operation. No other complications occurred. No obvious penile retraction was found twelve weeks postoperative.

The modified Devine’s technique was safe and effective. As a treatment for concealed penis, it is worthy of wide clinical application.

Thoracic ossification of the posterior longitudinal ligament (OPLL) is a rare condition that is mainlyaccompanied by cervical OPLL or ossification of thoracic ligamentum flavum. In case of causing neurologicalmanifestations, it is preferred to treat the condition surgically. Several surgical procedures were introduced,including anterior, posterior, or combined approaches. Laminectomy with instrumented fusion is the mostpopular procedure utilized via the posterior approach. A 32-year-old obese woman, who suffered from backpain and weakness in both lower extremities for one month, was referred to our spine outpatient clinic. Imagingrevealed lower thoracic OPLL (T7/T8 & T8/T9 & T9/T10). The posterior longitudinal ligament had a mixedossification pattern (beaked and continuing cylindrical). To maintain thoracic spine stability and prevent futurekyphosis, we performed laminectomy and long segment fixation (T7 to T12). The post-operative neurologicalexamination revealed a considerable increase in muscle strength and significant pain relief.

Management of a skin dimpling due to a chronic periapical lesion may pose challenges. This case report presents a multidisciplinary approach to resolving a persistent cutaneous scar of endodontic origin and also offers a flowchart for the management of similar cases.

Case report: 

A 34-year-old female referred to the Endodontics Department of Mashhad Dental School at Mashhad University of Medical Sciences, complained of a skin dimpling on her face with a history of pus discharge. Diagnostic workup and radiographic examination revealed that the right mandibular first molar had a failing root canal treatment and a defective restoration. The respective tooth underwent endodontic retreatment. Due to palpation of a cord-like tract at the apical region of the tooth, surgical removal of the mentioned structure was planned using a mucoperiosteal flap. After flap elevation, the cord was cut at the base of attachment to the bone, which resulted in immediate correction of facial contour. Finally, the tooth was permanently restored. At the 6-month follow-up visit, the periapical lesion was healing, and the face had a normal contour.

Considering the significance of surgical intervention in cases with a cord-like sinus tract and consequent skin dimpling, a flowchart for a step-by-step decision-making process is offered to better restore the normal facial contour.

Pleomorphic adenoma is the most common salivary gland tumor. This tumor mostly involves the parotid gland; however, if it occurs in the minor salivary glands, the palate would be the most common site. This lesion is more prevalent in patients with 40 to 60 years of age. Regarding the literature, the incidence of giant pleomorphic adenoma of the palate in young patients is considered a rare finding. Hereby, we present a rare case of pleomorphic adenoma of the palate, with an astonishing size, found in a 27-year-old patient. Furthermore, the surgical treatment of this lesion is described. This case was effectively treated with surgical curettage and tumor resection, emphasizing the significance of early detection in order to minimize complications. Surgical treatment, was beneficial to help the patient resume to normal life. Additionally, the clinical, radiological, and histopathological aspects and potential surgical treatments are discussed.

Unilateral absence of a pulmonary artery (UAPA) is an uncommon anomaly with an estimated prevalence of 1 in 200,000 young adults and a diverse clinical presentation. It may be diagnosed as an isolated anomaly or in combination with other congenital heart defects. The purpose of the present study was to investigate the clinical course and characteristics of forty patients with UAPA in whom the diagnosis was first established in childhood or adulthood.

From January 2002 through April 2021, 40 patients with unilateral absence of one pulmonary artery were diagnosed at our institution. We retrospectively reviewed the medical records of these patients in detail and elicited information covered patients' demographics, associated anomalies, imaging studies and operation data.

All forty patients were between 2 months and 25 years old (mean age, 6.45 years) at first presentation, weighing 4.70-59.00 kg (mean weight, 19.17 kg) and twenty five patients were female (62.5%). Absent left pulmonary artery (LPA) was found in 60% of cases (24 patients) and 40% had occult right pulmonary artery (RPA). Right-sided aortic arch was found in 4 patients (10%). Tetralogy of Fallot was diagnosed in 16 patients while complex cardiac anomalies were found in 13 cases.

clinicians should consider the undiagnosed cases of UAPA especially in adults with suspicious symptoms such as unexplained hemoptysis. Applying different available imaging techniques for early diagnosis and treatment of isolated UAPA cases are important to prevent the devastating complications of pulmonary hypertension and massive hemoptysis in long term.

To review various types of extraocular muscle transposition procedures for management of strabismus in sixth cranial nerve palsy with little lateral rectus (LR) muscle function, along with their pros and cons.

We performed a comprehensive review of transposition procedures in sixth cranial nerve palsy, based on literature published anytime up to March 2021. A thorough search through PubMed and Cochrane databases was performed. All types of clinical studies on different transposition procedures in LR palsy, were included.

Eighty-six original articles in English, with full text or abstracts available, were included in the review, among which 16 are prospective studies, 48 retrospective, 3 review articles, 1 randomized clinical trial, 17 case reports, and 1 letter. Vertical rectus transposition has demonstrated promising results, especially in abduction improvement and expansion of binocular diplopia‑free visual field, albeit the possible adverse effects such as anterior segment ischemia, especially in the presence of medial rectus contracture, and induced vertical deviation may become troublesome. Partial muscle transposition, single muscle transposition, and also transposition without tenotomy have all been introduced to reduce the risk of multiple muscle manipulation and ischemia. On the other hand, different adjustable transpositions are being utilized to manage concomitant or induced vertical deviations.

Transposition procedures are highly effective in the treatment of esotropia caused by complete LR palsy. Various techniques for vertical muscle transposition have been proposed, with each of them having certain advantages and disadvantages.

Context: 

Congenital scoliosis is a difficult condition for orthopedic surgeons. There are some influencing factors to choose the best treatment option for scoliosis. 

Patients with congenital scoliosis may encounter different anomalies. There exist various surgical techniques with different indications. 

Electronic databases, such as Google Scholar, PubMed, and Scopus were searched for congenital scoliosis. Articles published from 1928 to 2020 were searched. A narrative review was conducted by focusing on treatment options.

Different methods are presented in the literature that consists of operative and nonoperative approaches. Nonoperative treatment methods are seldom a final choice. They are used to postpone the final surgery. There are different methods of surgeries in the literature; the best treatment strategy concerns the patients’ condition and the surgeon’s preference. 

The critical issue in the management of congenital scoliosis is to diagnose these patients’ curves before severe progression, i.e. mandatory to achieve desirable results. Usually, a course of nonoperative treatment can be started, but only to postpone the final surgery. The preferred surgical treatment depends on the type of congenital scoliosis and the age of the patient. The treatment of congenital scoliosis should be a multidisciplinary approach due to concomitant morbidity in these patients.

The Cochrane Library makes the outcomes of well-conducted controlled trials quickly accessible and is an essential resource for evidence-based medicine.

The purpose of this article is to review the data on the surgical treatment of knee osteoarthritis currently provided by the Cochrane database of systematic reviews (CDBSR).

The main results included the following: Joint lavage and arthroscopic debridement have no benefit for osteoarthritis; valgus high tibial osteotomy (HTO) reduces pain and improves knee function in patients with medial compartmental osteoarthritis of the knee; in primary total knee arthroplasty (TKA) cemented fixation of the tibial components demonstrated less displacement compared with cementless fixation (with and without hydroxyapatite) after a follow‐up of two years; however, the cemented fixation presented a greater risk of future aseptic loosening than cementless fixation; clinically irrelevant differences have been found between retention and sacrifice of the posterior cruciate ligament (PCL) in primary TKA; moderate‐ to low‐quality evidence suggests that mobile-bearing prostheses can have similar effects on various parameters compared with fixed-bearing prostheses in PCL-retaining TKA.

The CDBSR discourages joint lavage and arthroscopic debridement, demonstrates the utility of the valgus HTO in patients with medial compartmental osteoarthritis of the knee, and suggests that the various design types in primary TKA offer similar results.

Context: 

The anatomy of the radial nerve is prone to entrapment, each with different symptomology. Compression of entrapment of the radial nerve can occur near the radiocapitellar joint, the spiral groove, the arcade of Frohse, the tendon of the extensor carpi radialis brevis (ECRB), and at the radial tunnel. Those who require repetitive motions are at increased risk of peripheral neuropathy syndromes, including repetitive pronation and supination, trauma, or systemic disease; however, t the influence of all risk factors is not well understood. Depending on the location of entrapment, radial nerve entrapment syndrome presents different symptoms. It may include both a motor component and a sensory component. The motor component includes a dropped arm, and the sensory component can include pain and paresthesia in the distribution of the radial nerve that resolves with rest and exacerbates by repetitive pronation and supination.

Evidence Acquisition: 

Diagnostic evaluation for radial nerve entrapment, apart from clinical symptoms and physical exam, includes electromyography, nerve conduction studies, ultrasonography, and magnetic resonance imaging. Conservative management for radial nerve entrapment includes oral anti-inflammatory medications, activity modification, and splinting. Some recently performed studies mentioned promising minimally invasive techniques, including corticosteroid injections, peripheral nerve stimulation, and pulsed radiofrequency.

 When minimally invasive techniques fail, open or endoscopic surgery can be performed to release the nerve

 Endoscopic surgery has the benefit of decreasing incision size and reducing time to functional recovery.
 

Context: 

Piriformis syndrome is a solely clinical diagnosis that often eludes the practitioner and goes underdiagnosed. PS is a pain syndrome and for those it affects, causes persistent pain and limits daily activity and work capacity. It is a form of deep gluteal syndrome that needs to be considered on the differential of low back pain as it comprises between 0.3% - 6% of all low back pain cases and is frequently underdiagnosed. Piriformis syndrome may be primary due anatomic anomalies or secondary, though the majority of cases are secondary to some insult. The objective of this manuscript is to provide a description of the epidemiology and presentation of piriformis as well as both non-operative and operative treatment options. We review all of the recent clinical evidence regarding the aforementioned therapies.

Evidence Acquisition: 

Literature searches were performed using the below MeSH Terms using Mendeley version 1.19.4. Search fields were varied until further searches revealed no new articles. All articles were screened by title and abstract. Decision was made to include an article based on its relevance and the list of final articles was approved three of the authors. This included reading the entirety of the article. Any question regarding the inclusion of an article was discussed by all authors until an agreement was reached.

 Medical management and physical therapy show some promise; however, when conservative treatment fails minimally invasive methods such as steroid injections, botulinum toxin injections, dry needling are all efficacious and there is substantial clinical evidence regarding these therapies. In those patients in which minimally invasive techniques do not result in an adequate relief of pain and return of function, endoscopic release can be considered. Endoscopic release is far superior to open release of the piriformis syndrome given the higher success and lower rate of complications.

 Piriformis syndrome is an important differential diagnosis in the work up of lower back pain and should not be ruled out with proper examination and testing. Clinicians should consider medical management and conservative management in the initial treatment plan for piriformis syndrome. There are many options within the conservative management and the literature shows much promise regarding these. Physical therapy, steroid injections, botulinum toxin injections, and dry needling are all potentially effective therapies with few adverse effects. Surgical options remain as gold standard, but only when conservative management has failed and the symptoms are significant to affect daily living activities. Endoscopic decompression of the sciatic nerve with or without release of the piriformis muscle has a reported high likelihood of success and a low complication rate. Current literature supports the preference of the endoscopic approach over the open approach due to improved outcomes and decreased complications. Further research is to well define the metrics for the diagnosis of piriformis syndrome and may include a need to develop diagnostic criteria.

Pyogenic granuloma is a pseudo-tumor which has a great tendency to attached gingiva. Conservative surgery is a treatment choice for this lesion. Among different laser wavelengths used for oral surgery including CO2, Nd:YAG, Erbium family and diode laser, diode can be the best option due to providing blood less area that make better view for surgeon to remove it completely.

A 14-year-old girl with a chief complaint of exophytic lesion in lower jaw was referred. The surgery was done by 980 diode laser with output power of 1 W in continuous mode. The lesion was sent to pathology laboratory for further investigation. The patient was advised to keep oral hygiene instructions.

 After 1 weeks, complete healing was observed.

 Diode laser can be a treatment choice for this kind of lesions due to diminished infection and bacteremia following surgery, reduction of relapse and bone degeneration, less invasive technique and reduced chair time.

Bleeding episodes in severe hemophilia may occur more frequently and spontaneously after mildtrauma or daily activities. An inadequate treatment of that bleeding in hemophilia may result in pseudotumor,usually in the muscle adjacent to the bone. We reported haemophilic pseudotumor treated with various surgicalinterventions. This study was conducted inthe Department of Orthopaedic and Traumatology at a government hospitalover a period of 7 years(2010 –2017). Patients Perioperative management was done in accordance with the IntegratedHemophilia Team of our institution protocol.Diagnosis and management planning of hemophilic pseudotumor wasconfirmed via Integrated HemophiliaTeam meeting. After the surgery, all patients were asked to come for routinefollow up. We reported six Haemophilia-A patients with pseudotumor in the pelvis, proximal femur and lowerleg. One case in pelvic bone underwent hematoma evacuation, acetabular reconstruction using the Harringtonprocedure, and total hip arthroplasty.Two cases, a case in the proximal femur and another case in the distal fibula,were treated with amputation, other two cases, one was soft tissue psedotumor in the pelvic region and wastreated by hematoma evacuation, and the remaining casewas managed with wide excision and followed by defectclosure. Surgery is a preferable treatment for pseudotumors that have been present for years.It’s associatedwith the best outcomes especially when selected as the primary line ofwith preventable and manageable bleedingcomplication. As previously published by many authors, this paper confirms that surgical excision is the treatment ofchoice but should only be carried out in major hemophilia centers by a multidisciplinary surgical team.Level of evidence: IV

Aneurysmal Bone Cysts (ABCs) are benign destructive tumors. Their diagnosis is sometimes challenging, and their treatment in unusual sites, especially in the pediatric age group is difficult, too. This study aims to support the paraclinical measures along proper consultation to approach the pelvic ABC.

We present a 9-year-old female who suffered from pain in the left hip 3 months before the referral. A pelvic mass was diagnosed and unfortunately misdiagnosed with an ovarian mass. It was led to a wrong operation with a wrong approach by a general surgeon and result in intra-operative bleeding and delay in diagnosis and treatment. the final diagnosis was massive ABC in the supra-acetabular area with extension to the ilium and pubic.

Pelvis is one of the most challenging sites for the diagnosis and treatment of bone tumors. Large ABC tumors in the hip are unusual and may be presented by non-specific signs and symptoms. Therefore complete clinical and radiological evaluations should be done before any attempt to surgically remove the pelvic mass. Prognosis is excellent if the pelvic mass remove wisely by an experienced hip surgeon.

Congenital diaphragmatic hernia (CDH) is associated with high mortality due to pulmonary hypoplasia, pulmonary hypertension, and concomitant anomalies. This condition is identified by the presence of an orifice in the diaphragm (mostly to the left and posterolateral), leading to the herniation of the abdominal contents into the thorax. Morgagni hernia is a less common CDH, accounting for only 5-10% of CDH cases. It is an uncommon congenital herniation of the abdominal content through the triangular parasternal gaps of the anterior diaphragm. This condition usually affects the right side, and the patients are usually asymptomatic. Herein, we presented the case of a 15-month-old male infant with large Morgagni hernia resulting in poor weight gain. The presentation was unique due to its huge orifice, its accompaniment with gastrointestinal obstruction, and also its unremarkable radiologic findings. The patient was monitored by the follow-up team for 12 months. The follow-up revealed no recurrence, and the patient had favorable weight gain without any gastrointestinal symptoms.

Pleomorphic adenomas are benign neoplasms of salivary glands. The simultaneous homolateral occurrence of these tumors in salivary glands is exceedingly rare.   Case Report: An adult female presenting to our OPD with the swelling of right-sided preauricular and submandibular regions was diagnosed with the pleomorphic adenoma based on fine needle aspiration cytology. The patient was subjected to the excision of both swellings under general anesthesia. Postoperative facial nerve functions were within normal limits and final histopathology confirmed pleomorphic adenoma involving both the sites. A pertinent detailed literature review of English and non-English studies was indicative of only nine such cases.   Simultaneously occurring pleomorphic adenoma involving homolateral parotid and submandibular glands is a rare phenomenon that should be kept in mind when examining the swelling of the unifocal salivary gland.

This study aimed to present the results of early and delayed operation on patients with ruptured brain aneurysms. In addition to comparing the results and rates of morbidity and mortality in the surgical procedure and identifying the effective factors, this study aimed to provide methods to improve the treatment of brain aneurysm. Methods and Materials/Patients: This was a retrospective study on 60 patients with a definitive diagnosis of brain aneurysm admitted to Neurosurgery Ward of Poursina Hospital, Rasht, Iran from 2009 to 2013. 7(11.7%) patients on the first 3 days and 37(61.7%) patients on the days 4-14 and 16(26.7%) after 2 weeks and selectively underwent surgery. In total, 11.7% of patients died and 15% developed severe complications. In the group underwent surgery on the first 3 days, 2(28.5%) patients died and 2 experienced severe complications. In the second group (in 4-14 days), 4(10.8%) patients died and 5(13.5%) suffered from severe complications, and in the group (16 patients) with delayed surgeries, 1(6.2%) patient died and 2(12.5%) suffered from severe complications. Neurological grading and operation time were important factors in complications and mortality of patients. This study showed that Hunt and Hess neurological grading score has a direct relationship with increased morbidity and mortality rates, while delayed operation is associated with a reduction in morbidity and mortality. Given the complications of early aneurysm surgery (during the first 3 days) compared with delayed surgery, and also most of these patients die due to vasospasm or recurrent hemorrhage before the onset of a delayed phase, performing early surgery in these patients requires further evaluation. According to this study, the reduction of each episode of occlusion with temporary clipping will result in fewer complications.

Various treatments have been proposed to treat ectopic pregnancy, but their impact on future pregnancies is still the subject of controversy.

The aim of this study is to compare the medical and surgical treatment methods and their impact on the subsequent fertility results and complications in women with a history of ectopic pregnancy.

In this analytical, cross-sectional study, 370 women with the history of ectopic pregnancy, (treared with single dose of methotrexate or salpingectomy by laparotomy), that referred to Al-Zahra Hospital, Rasht, Guilan between 2009 to 2013 were enrolled. 147 women responded to the phone call. The age, the number of women that needed to drug for pregnancy, fertility rate and the fertility outcomes were studied.

147 women responded to the call and between them, 114 women tried to get pregnant again after the ectopic pregnancy treatment. They were agreed to the participate in the study. The mean age of the patients was 28.56±5.63 yr. The fertility rates in the medical and the surgical groups were 56.6% and 47.61%, respectively (p=0.141). There were no significant differences in the poor consequences of pregnancy among the two groups; ectopic pregnancy (p=0.605), miscarriage (p=0.605), and prematuredelivery (p=0.648). 15.1% in the medicinal group and two patients 12.5% in the surgical group had received fertility treatment in order to get pregnant (p=0.135). There was no significant difference in two groups.

It seems that surgical treatment depending on the underlying variables of each patient, can be used such as medical treatment, without worrying about its effect on fertility.